A new report from the Urban Institute projects that millions of Americans who depend on Medicaid may soon lose their benefits due to changes to eligibility requirements included in President Donald Trump’s most recent budget law.
Trump signed H.R. 1, also known as the One Big Beautiful Bill Act, into law in July 2025. The law mandates that states conduct twice-yearly eligibility reviews and imposes new work requirements for Medicaid recipients.
The Urban Institute’s modeling projected that the new requirements could lead to a loss in coverage for between 4.9 and 10.1 million people in 2028.
According to the Wisconsin Department of Health Services’ ForwardHealth public portal, there are 1.2 million Wisconsinites enrolled in Medicaid. The department estimated in an analysis published a month before Trump signed the bill that approximately 63,000 Wisconsinites could be at risk of losing Medicaid coverage, primarily due to the new work requirements.
Barbara Lockington of Holman, Wisconsin, is disabled and currently on Medicare. She receives Social Security Disability Income through Medicaid, which is based on state-specific income rules. In Wisconsin, SSDI is available to those with severe long-term disabilities.
Lockington, who is 50, has metabolic dysfunction-associated steatohepatitis, a genetic disease that, without treatment, can cause liver cancer or cirrhosis. Five years ago, Lockington had a liver transplant, and she remains on multiple medications. She said she is afraid she will lose coverage and be forced to pay more for her medical care as a result of the new requirements.
“As far as the work requirements, I physically cannot make those work requirements. I just can’t,” Lockington told the Wisconsin Independent. “I wish I could get people to understand that pain in and of itself is extremely debilitating. As far as this Big Beautiful Bill thing goes, the fear is so real.”
Lockington said she owes almost $500 to the local hospital she regularly visits for treatment due to changes that have taken effect already, including copays that are no longer covered.
“I’m going to have to not pay as much on my electricity bill so I can send that over to them, and then next month, I’ll have to skip paying part of the hospital bill — you have to rob Peter to pay Paul, because everybody thinks you get this free, that free: You do not get free everything, you really don’t.”
Lockington said being on Social Security Disability Insurance, Medicare, and Medicaid can feel degrading. She said: “You just never know when something is going to happen, and the rug is going to be pulled out from underneath of you. I have worked since I was 15 years old, and then all of a sudden I couldn’t.” Before she became ill, Lockington worked for nearly 20 years as a phlebotomist.
The Commonwealth Fund, a health care advocacy foundation, notes that work requirements under the Trump budget law for people ages 19-64 enrolled in expanded Medicaid programs will take effect on Jan. 1, 2027, and that states need to set up systems to comply with reporting requirements. The fund says that enrollees will have to provide proof of “working, volunteering, or engaging in educational activities for a minimum number of hours,” typically about 80 hours per month. The law exempts recipients who are disabled, pregnant, or caring for a child under 14 years old. The Congressional Budget Office estimates the work requirements could affect an estimated 18.5 million people nationwide by 2034.
ForwardHealth projects that 16% of all Wisconsin enrollees will be subject to work requirements or will have to prove they are eligible for an exemption.
Christine Hyde worked as a registered nurse for over a dozen years and now works as a nurse practitioner at a Planned Parenthood clinic in Green Bay, where she lives.
Hyde said many of her patients are either very young or in their early 60s and older and often don’t hold jobs that offer health insurance, or have insurance that comes with high deductibles.
“So, for people to have to get off of Medicaid and take their employer’s insurance, it’s often at a huge cost to them, which then will cause them to forgo other things in their life,” Hyde said.
“Most of the patients that are on Medicaid are working, and if the work requirements change, and so, say they have to work more hours, then they’ll likely fall off of Medicaid, and then if they can’t afford their employer’s insurance, a lot choose to go uninsured, which is a scary thought, as a clinician, to think about people having potentially preventative care situations that are going untreated and undiagnosed,” Hyde said. “And that’s just going to put a further strain on our health system.”
If she had the chance to speak with her lawmakers, Lockington said, she’d tell them: “Congratulations that you have now signed the death warrant of how many thousands of American citizens — literally, their death warrants, because without that, people are not going to be able to afford to go to the doctor. They’re not going to be able to afford their medicines to stay alive. They’re not going to be able to do anything, not chemo, not their monthly medicines. I won’t be able to afford my anti-rejection meds. You went ahead and signed thousands of death warrants.”
By Rebekah Sager for the Wisconsin Independent.
Broadcast version by Judith Ruiz-Branch for Wisconsin News Connection reporting for the Wisconsin Independent-Public News Service Collaboration
