By Sam Whitehead
April 9, 2026 / 5:00 AM EDT / KFF Health News
Katie Crouch says calling her state’s Medicaid agency for information about benefits often feels like a dead end. “The first time, it’ll ring interminably. Next time, it’ll go to a voice mail that just hangs up on you,” said the 48-year-old Delaware resident. Calls get transferred and dropped, go unanswered, or reach staff who say they’re not the right person. After months 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, had relied on Medicaid to pay a $200 monthly Medicare deductible. She hasn’t received that help for three months, squeezing her family’s fixed income. Her difficulties reaching Delaware’s Medicaid call center reflect broader problems: state agencies often struggle to keep enough staff to help people sign up, renew, and answer questions. Researchers say staffing shortages can block access to benefits.
Congressional Republicans’ One Big Beautiful Bill, signed by President Donald Trump last summer, will increase demands on state Medicaid staff in places that expanded the program — nearly all states and D.C. The law, projected to 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. Agencies must determine whether millions meet the new work requirements and verify eligibility more often, tasks that KFF Health News found many states expect will require hiring additional workers.
The mandates will add strain to an already taxed workforce and could make it harder for enrollees like Crouch to get basic customer service. “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 agency official. “There will be significant additional challenges caused by these changes.”
Long wait times and delayed processing
Republicans say the changes, which take effect Jan. 1, 2027 in most states, will encourage employment. Research on previous Medicaid work requirements has shown little evidence of increased employment. The Congressional Budget Office estimated the rules would cause more people to lose coverage by 2034 than any other part of the GOP budget law, and said last year more than 5 million people could be affected.
Many states already lack the capacity 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 publicly sharing 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 protections ended — more than 25 million people lost benefits, an experience advocates say shows how quickly people can lose coverage amid administrative friction.
Rolling out the new rules will require substantial IT changes and retraining eligibility workers on a tight timeline. “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 a cost of $6.2 million. Pennsylvania has nearly 400 open county human services positions; Indiana has 94; Maine wants 90 additional hires; and Massachusetts aims for 70 more. Montana had filled 39 of 59 projected positions as of early March but still plans an early July rollout despite backlogs that have delayed benefits.
Missouri’s social services agency has about 1,000 fewer frontline workers than a decade ago while serving more than double the number of Medicaid and SNAP enrollees, agency leaders said. Some expected efficiency gains from eligibility systems never materialized. Researchers warn states may struggle to recruit staff for these roles because the jobs require months of training, can be emotionally draining, and typically 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 contracting private vendors to help comply with the federal law. Maximus, a government services contractor, provides eligibility support and call centers in 17 expansion states and interacts with nearly 3 in 5 people enrolled in Medicaid nationally. Company executives have said they can charge based on transactions completed for enrollees, regardless of enrollment numbers. Maximus reported $1.76 billion in 2025 revenue from the part of its business that includes Medicaid work and expects that revenue to grow because of increased administrative transactions.
Consequences of coverage loss
Losing Medicaid coverage can be devastating for people who cannot afford health care and may not qualify for subsidies on the Affordable Care Act marketplace. Without coverage, people could forgo medications or essential care, leading to 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 that, 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.
KFF correspondents Katheryn Houghton and Samantha Liss contributed reporting.
KFF Health News is a national newsroom producing in-depth journalism about health issues and is a core program of KFF, the independent source for health policy research, polling, and journalism.