Medicaid work reporting rules and local responses: Lessons from two Michigan communities

• In Event: Effects of HR1 Implementation on Medicaid Enrollment and Mitigation Strategies

Abstract

Introduction/Background: The passage of HR 1 in July 2025 has ushered in a 50-state experiment in implementing work requirements at scale for the Medicaid expansion population. Most of what we know about such requirements comes from a similar policy in place for 9 months in 2018 in Arkansas. The results were not encouraging: 18,000 Medicaid recipients (or 1 in 4) lost coverage, mainly due to a failure to report work status or document eligibility for an exemption (Hinton 2025). Vulnerable groups (the unhoused, those with disabilities, those lacking transportation) were especially harmed by the Arkansas experiment, while younger adults and less-educated individuals were the least likely to be aware of the requirements (Musumeci 2018). Miscommunication persisted despite extensive state outreach, and many disenrolled individuals were unaware they had lost coverage until they tried to access medical services (Sommers 2020).

With all states now required to implement an 80-hour monthly “community engagement” provision for their Medicaid expansion population, redetermine benefit eligibility every six months, and implement these policies later this year, many are worried. In Michigan, it is estimated that up to 200,000 recipients could lose coverage (Citizens Research Council of Michigan 2025). Can local outreach and navigation, in concert with state efforts, help residents meet the administrative burden posed by the new rules? An analysis of two county-level approaches in Michigan should provide some answers.

Purpose/Question: This study traces the evolution of the Kent County (Grand Rapids) Medicaid Task Force and the Medicaid Access Coalition of Kalamazoo. Both initiatives arose in late 2025 and involve cross-sector coalitions of local hospitals, health care providers, social service agencies, and nonprofit organizations. The Grand Rapids effort started earlier, has a broader writ, and is closely aligned with area healthcare providers; in Kalamazoo, the focus is on work requirements, and the effort is led by area nonprofits. Our study compares these initiatives’ origins, their goals and activities (including interaction with statewide outreach efforts), and plans to evaluate their impacts.

Research Methods: Qualitative research based on interviews and participant-observation will provide insight into the dynamics behind such local coalitions and their range of activities. A cost-benefit analysis will guide understanding of the individual and social rates of return to providing enhanced navigation at the local level.

Policy Implications: Our analysis of these coalitions may offer a blueprint for other communities seeking to protect health insurance access for their vulnerable residents—and the economic safety net it provides—while complying with the new law.

Author

• Michelle Miller-Adams, W. E. Upjohn Institute for Employment Research
  Presenting Author