Katie Crouch says calling her state Medicaid office often feels futile. “The first time, it’ll ring interminably. Next time, it’ll go to a voice mail that just hangs up on you,” the 48-year-old Delaware resident said. Calls are transferred, dropped, or answered by staff who cannot help. After months of trying to learn whether her Medicaid had been renewed, she still lacked annual reapproval as of late March.
Crouch, who has Medicare because of a disability from a brain aneurysm, depended on Medicaid to cover a $200 monthly Medicare deductible. That help has not arrived for three months, squeezing her family’s fixed income. Her experience reflects a broader problem: many state Medicaid agencies lack enough staff to help people apply, renew coverage, and get answers — and researchers warn that understaffing can block access to benefits.
A provision in the GOP budget package known as the One Big Beautiful Bill, signed by President Donald Trump last summer, will increase demands on state eligibility systems in nearly every state and D.C. The law, which the Congressional Budget Office projects will cut Medicaid spending by nearly $1 trillion over eight years, requires new work rules for many enrollees and more frequent eligibility checks — every six months instead of annually in most states. Agencies must determine whether millions meet the new work requirements and verify eligibility more often, tasks that many states expect will require hiring new workers.
“States are struggling significantly,” said Jennifer Wagner, director of Medicaid eligibility and enrollment at the Center on Budget and Policy Priorities and a former state official. “There will be significant additional challenges caused by these changes.”
Long wait times and delayed processing
Republicans argue the changes, which take effect Jan. 1, 2027 in most states, will encourage employment. Research from prior experiments with Medicaid work requirements has shown little evidence of increased employment, and the CBO estimated the rules could lead to more people losing coverage than any other part of the GOP budget law. Last year the agency said more than 5 million people could be affected.
Many states already struggle to process applications and renewals quickly. The Centers for Medicare & Medicaid Services tracks whether states meet a 45-day processing window for the most common applications. In December, roughly 30% of Medicaid and CHIP applications in Washington, D.C., and Georgia took more than 45 days; more than a quarter did in Wyoming; and in Maine one in five missed that deadline.
CMS began publishing state Medicaid call center data in 2023, revealing long wait times. In December, callers in Hawaii waited over three hours, in Oklahoma nearly an hour, and in Nevada more than an hour. During the 2023–24 Medicaid unwinding — when states resumed eligibility checks after pandemic-era protections ended — more than 25 million people lost benefits, an episode advocates say shows how quickly coverage can be lost amid administrative friction.
Implementing the new requirements will also demand substantial IT changes and retraining eligibility workers on a tight timetable. “It is a much larger scale of administrative complexity,” said Sophia Tripoli, senior director of policy at Families USA.
Staffing shortfalls and hiring challenges
Several states told KFF Health News in late March they will need more staff to implement the work rules. Idaho reported 40 eligibility worker vacancies. New York estimated needing 80 new employees at an expected cost of $6.2 million. Pennsylvania has nearly 400 open county human services positions; Indiana 94; Maine says it needs 90 additional hires; and Massachusetts aims for 70 more. Montana had filled 39 of 59 projected positions as of early March but plans an early July rollout despite backlogs that have delayed benefits.
Missouri’s social services agency says it has about 1,000 fewer frontline workers than a decade ago while serving more than double the number of Medicaid and SNAP enrollees. Some hoped-for efficiency gains from modernized eligibility systems have not materialized. Experts warn states may struggle to recruit and retain staff because these jobs require months of training, can be emotionally draining, and often pay modestly. “They get yelled at a lot,” said Tricia Brooks of the Georgetown University Center for Children and Families, a former state program manager.
States are also turning to private contractors to help comply with the federal law. Maximus, a government services contractor, provides eligibility support and call centers in 17 Medicaid expansion states and interacts with nearly three in five people enrolled in Medicaid nationally. Company executives have said they can bill based on transactions completed for enrollees, regardless of total enrollment; Maximus reported $1.76 billion in 2025 revenue from the part of its business that includes Medicaid work and expects that revenue to grow as administrative transactions increase.
Consequences of coverage loss
Losing Medicaid can be devastating for people who cannot afford health care and may not qualify for Affordable Care Act marketplace subsidies. Without coverage, people may skip medications or essential care, risking serious health consequences. “The human stakes of this are people’s lives,” said Elizabeth Edwards, senior attorney with the National Health Law Program.
Crouch finally got answers only after contacting the office of U.S. Rep. Sarah McBride (D-Del.), which reached Delaware’s Medicaid agency. The state later told her she did not qualify for Medicaid — a determination she said had never been raised in two years of interactions with the agency. Delaware’s Medicaid agency did not respond to requests for comment on her case.
The shift to more frequent checks and work reporting, combined with existing staffing and technology shortfalls, could make it harder for many people to keep coverage or get timely help. Researchers, advocates, and state officials say preparing to implement the new rules will require hiring, training, IT upgrades, and careful planning — all under tight deadlines and amid ongoing workforce challenges.
KFF correspondents Katheryn Houghton and Samantha Liss contributed reporting. KFF Health News produces in-depth journalism about health policy and public health.