‘Keep seeking care. Take your meds.' With Trump's budget now law, Mass. officials prepare for major Medicaid cuts

Boston Globe

10-07-2025

'This is more about, frankly, Congress putting administrative burdens between people and their health care,' said Mike Levine, assistant secretary for MassHealth, the state's Medicaid administrator. But, 'we have a really good playbook for getting over those hurdles.'
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The new law is
projected to increase the number of uninsured in the country by
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To keep coverage, most able-bodied adults between 19 and 64 years old without dependent children will eventually have to document they are either working, in school, or volunteering at least 80 hours a month.
That provision is intended to weed out people shirking employment. In reality, the vast majority of the millions of able-bodied adults on Medicaid are either working, attending school, or have other limiting conditions, according to the
The
The law also scales back the state's ability to generate revenue for Medicaid through assessments on health care providers. State officials have not yet calculated the full cost of those limitations but said such assessments generated $2.4 billion in fiscal year 2025.
In Massachusetts, those at risk of losing coverage include about 200,000 people on Medicaid and another 100,000 who buy insurance
through the Massachusetts Health Connector, the health insurance marketplace set up under the Affordable Care Act.
The new law raises premiums, increases paperwork, and requires consumers to do more to maintain their coverage, the health policy analysis organization
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'It doesn't make those individuals ineligible for coverage writ large, but it takes away the primary subsidy that makes the coverage affordable,' said Audrey Gasteier, executive director of the Massachusetts connector.
Massachusetts Health Connector Executive Director Audrey Morse Gasteier.
Leah Willingham/Associated Press
MassHealth hopes to conduct extensive background checks on many Medicaid enrollees to prove their eligibility without having to
directly request information, Levine said. That will include reviewing Department of Revenue records to confirm employment or past claims for references to exempting conditions.
Those whom the state cannot confirm on its own will be notified their coverage is at risk and will need to prove their eligibility. But MassHealth's previous experience with mass mailings suggests many will slip through the cracks. So the agency expects to conduct an outreach effort similar one after the pandemic that could include door-to-door canvassing and partnering with community organizations.
Massachusetts has some time, Levine emphasized. Most of the new Medicaid requirements won't begin to take effect until after the 2026 midterm elections.
'Keep seeking care,' Levine advised the roughly 2 million MassHealth enrollees. 'Take your meds. You don't need to hoard them. You are not losing coverage tomorrow.'
Amy Rosenthal, executive director of the Boston nonprofit Health Care for All that helped coordinate the previous outreach, said similar efforts could help many keep their coverage. The organization hopes to be involved in the coming effort.
'Some of these red-tape barriers are ones that Massachusetts is uniquely positioned to help people overcome,' said Rosenthal.
New requirements, though, will be be costly for states that will have to update software and add staff, Adrianna McIntyre, assistant professor of health policy and politics at Harvard T.H. Chan School of Public Health, said at a Harvard-hosted media briefing Tuesday.
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'There is more opportunity for people to fall through the cracks,' she said. 'When things can't be done on an automated basis, you need case workers.'
The state of Georgia implemented a work requirement as part of a Medicaid expansion that cost $92 million, much of it for tech upgrades, according to the
The Massachusetts Health & Hospital Association said Monday the new law will have 'staggering implications' for health care and would lead to 'millions of uninsured people seeking care at underfunded hospitals.'
The hospital association said the state's Health Safety Net fund, which helps cover medical care for uninsured patients, will have a shortfall of $290 million in fiscal 2026, $10 million more than the year before. The association is lobbying state officials to funnel more money into the fund, arguing the current number of uninsured and underinsured people in Massachusetts is already straining resources, 'never mind another 300,000 or more people without coverage.'
Dr. Michael VanRooyen, chair of the emergency departments at Mass General Brigham's 10 hospitals, said he is worried patients who lose insurance will put off routine care until they have health crises. Then they will end up in already crowded emergency rooms.
'We can expect that some people will lose coverage or have lapses in coverage,' said VanRooyen, who is also a professor of emergency medicine at Harvard Medical School. 'When that happens, emergency departments become the safety net.'
A high number of patients who end up in emergency rooms don't speak English, VanRooyen said. Many are already afraid to seek treatment because of the Trump administration's efforts to deport undocumented immigrants. Some need treatment for mental illness or substance abuse.
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Meanwhile, the increased strain will be accompanied by a loss of important revenue MassHealth relies on to support Medicaid: taxes on health care providers. The new law limits taxes on providers to 3.5 percent, far less than what Massachusetts now imposes.
Levine said the state doesn't have enough information yet to determine how hard Massachusetts will be hit financially. He acknowledged the state will likely be forced to cut access to some services, though it was too soon to say what would be affected.
'The math is pretty straightforward,' Levine said. 'You need to take a hard look at what we do with the dollars we have available to us.'
Jason Laughlin can be reached at