2026年4月9日 美国东部时间凌晨5:00 / KFF健康新闻
凯蒂·克劳奇表示，拨打所在州的医疗补助计划机构电话咨询福利信息，感觉就像走进了一连串死胡同。
“第一次打电话，铃声会没完没了地响。下次打，会转到语音信箱，然后直接挂断，”这位住在特拉华州的48岁女子说，“有时会接通，有人接电话却说自己不是负责相关事务的，然后转接电话，接着就挂了。有时候电话接通了，那边却没人说话。”
她花了数月时间试图弄清楚自己的医疗补助覆盖范围是否已更新。截至3月下旬，她未能通过这项州联邦项目的年度重新审批。该项目为低收入人群和残疾人提供医疗保险。
克劳奇十年前患过严重的脑动脉瘤，同时也享受医疗保险，该保险面向65岁以上人群或残疾人。医疗补助计划原本一直在为她支付每月200美元的医疗保险免赔额，但过去三个月她不得不自掏腰包，她说这给家里固定收入带来了压力。
克劳奇在特拉华州医疗补助热线中心遇到的问题并非个例。州医疗补助机构往往难以留住足够的员工，以帮助人们申请福利并接听参保人的咨询电话。卫生政策研究人员表示，这类工作人员的短缺会导致人们无法充分享受应得的福利。
如今，国会共和党人的《宏大美好法案》——去年夏天由唐纳德·特朗普总统签署成为法律——很快将对那些已将医疗补助计划覆盖范围扩大到更多低收入成年人的州（几乎所有州和哥伦比亚特区）的机构工作人员提出更高要求。
根据该法案，预计未来八年内将减少近1万亿美元的医疗补助计划支出，这些工作人员不仅要确定数百万参保人是否符合该项目新的工作要求，还需更频繁地核实他们的参保资格——改为每半年核查一次，而非此前的每年一次。
KFF健康新闻联系了需要落实工作要求的各机构，许多机构表示需要增加人手。
消费者权益倡导者和卫生政策研究人员表示，这些强制要求将给本已紧张的劳动力队伍带来额外负担，可能会让克劳奇这样的参保人更难获得基本的客户服务，许多人甚至可能失去依法应享有的福利。其中一些研究人员曾在州级机构有过直接工作经验。
预算与政策优先中心负责医疗补助资格与参保事务的主任、前伊利诺伊州人类服务部副主任詹妮弗·瓦格纳表示，各州已经“面临巨大困难”，“这些变化将带来大量额外挑战”。
求助等待时间漫长
共和党方面称，这项将于2027年1月1日在大多数州生效的医疗补助计划改革，将鼓励参保人寻找工作。针对其他医疗补助计划工作要求项目的研究发现，几乎没有证据表明这些措施能提高就业率。
国会预算办公室估计，到2034年，这些规定将导致比共和党预算法案其他任何部分都更多的人失去医疗保险。该办公室去年表示，超过500万人可能会受到影响。
消费者权益倡导者和研究人员表示，许多州没有足够的人员快速处理医疗补助计划的申请或续保事宜。
医疗保险和医疗补助服务中心会跟踪各州能否在45天的窗口期内处理最常见类型的福利申请。
去年12月，华盛顿特区和佐治亚州约30%的医疗补助计划和儿童健康保险计划（CHIP）申请处理时间超过45天。怀俄明州超过四分之一的申请未能按时完成。缅因州五分之一的申请错过了这一截止日期。
研究人员和消费者权益倡导者表示，医疗保险和医疗补助服务中心从2023年开始公开分享各州医疗补助计划热线中心的数据，揭露了该系统负担过重的现状。
去年12月，夏威夷州民众的电话等待时间超过三小时。俄克拉荷马州民众等待了近一小时，内华达州民众等待了一个多小时。
2023年，各州医疗补助机构开始确保在新冠疫情期间免于被终止参保的人员仍符合参保资格。这项“医疗补助计划解绑”流程在许多州进展并不顺利，超过2500万人失去了福利保障。
卫生政策研究人员和消费者权益倡导者表示，落实新的医疗补助计划规则将是一项更大的挑战。医疗补助计划的工作要求将需要对信息技术系统进行大规模改造，并在紧迫的时间范围内对负责核查资格的工作人员开展新培训。
“这在行政复杂度上规模要大得多，”美国医疗消费者权益组织美国家庭联盟的高级政策主任索菲亚·特里波利说道。
在打了数月电话都无人接听后，克劳奇说，她在写信给美国众议院议员萨拉·麦克布莱德（特拉华州民主党）的办公室后，终于得到了关于其医疗补助福利问题的答复。麦克布莱德的办公室联系了州医疗补助机构，该机构最终致电告知了最新进展，克劳奇说。
克劳奇最终并未符合医疗补助计划的参保资格。她说，在两年内与该州的两次接触中，这一点从未被提及过。
“州政府从未意识到她本不该参保，这完全说不通，”克劳奇说道。
特拉华州医疗补助机构未回应置评请求，针对克劳奇的情况。
各州医疗补助计划人员配备不足
一些州在3月底告诉KFF健康新闻，他们需要增加人手才能有效落实工作要求。
爱达荷州表示有40个资格审核岗位空缺。纽约州估计需要雇佣80名新员工来处理额外的行政工作，成本为620万美元。宾夕法尼亚州表示，该州县一级的人类服务办公室有近400个空缺职位。印第安纳州医疗补助机构有94个空缺岗位。缅因州希望雇佣90名额外工作人员，马萨诸塞州则希望雇佣70名。
截至3月初，蒙大拿州已填补了其预计所需的59个岗位中的39个。尽管该州长期存在系统积压问题，申请人称这导致福利发放延迟，但该州仍计划于7月1日提前落实这些规则。
密苏里州社会服务机构一直在裁员，一线工作人员比十年前减少了1000人——而医疗补助计划和补充营养援助计划（SNAP）的参保人数却翻了一番，该机构主任杰西卡·巴克斯在11月的一次公开会议上如此表示。
“该部门曾认为，资格审核系统升级将提高效率，”巴克斯说，“但许多预期效果并未实现。”
乔治敦大学儿童与家庭中心研究员特里西娅·布鲁克斯表示，各州可能很难找到愿意从事这些工作的人。这类工作需要长达数月的培训，可能会带来情绪上的挑战，而且薪资普遍较低。
“他们经常会被人大声呵斥，”曾运营新罕布什尔州医疗补助计划和儿童健康保险计划客户服务项目的布鲁克斯说道，“人们情绪沮丧，会哭泣，会感到担忧，他们可能会失去医疗保障，所以当很难真正帮到别人时，这份工作并不容易做。”
各州正在向政府承包商支付数百万美元，以帮助他们遵守新的联邦法律。
根据政府服务承包商Maximus的说法，该公司为17个扩大了医疗补助计划覆盖范围的州提供资格审核支持，例如运营热线中心，服务了全国近五分之三的医疗补助计划参保人员。
在2月份的财报电话会议上，该公司管理层表示，Maximus可以根据其为参保人完成的交易数量收费，而与该州医疗补助计划的参保人数无关。
Maximus发言人马西·戈尔茨坦告诉KFF健康新闻，该公司“没有一刀切的服务模式”，收费方式也各不相同。
该公司负责医疗补助工作相关业务的2025年营收为17.6亿美元，首席财务官兼财务主管大卫·穆特林在财报电话会议上表示，即使参保人数减少，该业务收入预计仍将持续增长，“因为需要处理的额外交易将越来越多”。
国家健康法律项目的高级律师伊丽莎白·爱德华兹表示，失去医疗补助计划的健康保险不仅仅是不便，因为许多参保人可能收入过低，无法自行负担医疗费用，也可能无法获得《平价医疗法案》覆盖范围的经济援助。
人们可能无力承担药物费用或无法获得必要的护理，这可能导致“毁灭性的”健康影响，她说。
“这件事关乎的是人的生命，”她说。
_KFF通讯员凯瑟琳·霍顿和萨曼莎·利斯为本报道贡献了内容。
KFF健康新闻是一家专注卫生议题深度报道的全国性新闻编辑部，也是KFF的核心运营项目之一。KFF是独立的卫生政策研究、民意调查和新闻资讯来源。
Medicaid work rules will stress states’ staffing capacity
April 9, 2026 5:00 AM EDT / KFF Health News
Katie Crouch says calling her state’s Medicaid agency to get information about her benefits can feel like a series of dead ends.
“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, who lives in Delaware. “Sometimes you’ll get a person who says they’re not the right one. They transfer you, and it hangs up. Sometimes, it picks up and there’s just nobody on the line.”
She spent months trying to figure out whether her Medicaid coverage had been renewed. As of late March, she hadn’t been reapproved for the year for the state-federal program, which provides health insurance for people with low incomes and disabilities.
Crouch, who suffered a debilitating brain aneurysm a decade ago, also has Medicare, which covers people who are 65 or older or have disabilities. Medicaid had been paying her monthly Medicare deductibles of $200, but she’d been on the hook for them for the past three months, straining her family’s fixed income, she said.
Crouch’s challenges with Delaware’s Medicaid call center aren’t unique. State Medicaid agencies can struggle to keep enough staff to help people sign up for benefits and field calls from enrollees with questions. A shortage of such workers can keep people from fully using their benefits, health policy researchers said.
Now, congressional Republicans’ One Big Beautiful Bill Act, which President Donald Trump signed into law last summer, will soon demand even more from staff at state agencies in places where lawmakers expanded Medicaid to more low-income adults — nearly all states and the District of Columbia.
Under the law, which is expected to reduce Medicaid spending by almost $1 trillion over the next eight years, these staffers will have to not only determine whether millions of enrollees meet the program’s new work requirements but also verify more frequently that they qualify for the program — every six months instead of yearly.
KFF Health News reached out to agencies that will need to stand up the work rules, and many said they’ll need additional staff.
The mandates will put additional strain on an already stressed workforce, potentially making it even harder for enrollees like Crouch to get basic customer service. And many could lose access to benefits they’re legally entitled to, said consumer advocates and health policy researchers, some of them with direct experience working at state agencies.
States are already “struggling significantly,” said Jennifer Wagner, the director of Medicaid eligibility and enrollment at the Center on Budget and Policy Priorities and a former associate director of the Illinois Department of Human Services. “There will be significant additional challenges caused by these changes.”
Long wait times for help
Republicans argue the Medicaid changes, which will take effect Jan. 1, 2027, in most states, will encourage enrollees to find jobs. Research on other Medicaid work requirement programs has found little evidence they increase employment.
The Congressional Budget Office estimated the rules will cause more people to lose health coverage by 2034 than any other part of the GOP budget law. It said last year more than 5 million people could be affected.
Many states don’t have the staff to process Medicaid applications or renewals quickly, said consumer advocates and researchers.
The Centers for Medicare & Medicaid Services tracks whether states can handle the most common type of benefit application within a 45-day window.
In December, about 30% of all Medicaid and Children’s Health Insurance Program, or CHIP, applications in Washington, D.C., and Georgia took more than 45 days to process. More than a quarter took that long in Wyoming. In Maine, 1 in 5 applications missed that deadline.
CMS began publicly sharing state Medicaid call center data in 2023, revealing a taxed system, researchers and consumer advocates said.
In Hawaii, people waited on the phone for more than three hours in December. They waited for nearly an hour in Oklahoma, and more than an hour in Nevada.
In 2023, state Medicaid agencies began making sure enrollees who were protected from being dropped from the program during the covid pandemic still qualified for coverage. That Medicaid unwinding process didn’t go well in many states, and more than 25 million lost their benefits.
Health policy researchers and consumer advocates say rolling out the new Medicaid rules will be a bigger challenge. The Medicaid work rules will require extensive IT system changes and new training for workers verifying eligibility on a tight timeline.
“It is a much larger scale of administrative complexity,” said Sophia Tripoli, senior director of policy at Families USA, a health care consumer advocacy organization.
After months of trying to get someone on the phone, Crouch said, she finally got answers to questions about her Medicaid benefits after writing to the office of U.S. Rep. Sarah McBride (D-Del.). McBride’s office contacted the state’s Medicaid agency, which eventually called with an update, Crouch said.
Crouch didn’t qualify for Medicaid after all. She said that had never come up in two years of interactions with the state.
“It makes absolutely no sense” that the state never realized she shouldn’t have been on the program, Crouch said.
Delaware’s Medicaid agency didn’t respond to requests for comment on Crouch’s situation.
States short-staffed for Medicaid
Some states told KFF Health News in late March that they’ll need more staff to roll out the work rules effectively.
Idaho said it has 40 eligibility worker vacancies. New York estimated it will need 80 new employees to handle the additional administrative work, at a cost of $6.2 million. Pennsylvania said it has nearly 400 open positions in county human services offices in the state. Indiana’s Medicaid agency has 94 open positions. Maine wants to hire 90 additional staffers, and Massachusetts wants to hire 70 more.
As of early March, Montana had filled 39 of 59 positions state officials projected it would need. The state still plans to roll out the rules early, starting July 1, despite its long struggle with system backlogs that applicants said have delayed benefits.
Missouri’s social services agency has been cutting staff and has 1,000 fewer frontline workers than it did roughly a decade ago — with more than double the number of enrollees in Medicaid and the Supplemental Nutrition Assistance Program, or SNAP, according to comments Jessica Bax, the agency director, made during a public meeting in November.
“The department thought that there would be a gain in efficiency due to eligibility system upgrades,” Bax said. “Many of those did not come to fruition.”
States could have a hard time finding people interested in taking those jobs, which require months-long training, can be emotionally challenging, and generally offer low pay, said Tricia Brooks, a researcher at the Georgetown University Center for Children and Families.
“They get yelled at a lot,” said Brooks, who formerly ran New Hampshire’s Medicaid and CHIP customer service program. “People are frustrated. They’re crying. They’re concerned. They’re losing access to health care, and so sometimes it’s not an easy job to take if it’s hard to help someone.”
States are paying government contractors millions of dollars to help them comply with the new federal law.
Maximus, a government services contractor, provides eligibility support, such as running call centers, in 17 states that expanded Medicaid and interacts with nearly 3 in 5 people enrolled in the program nationally, according to the company.
During a February earnings call, company leadership said Maximus can charge based on the number of transactions it completes for enrollees, independent of how many people are enrolled in a state’s Medicaid program.
Maximus has “no one-size-fits-all approach” to the services it offers or the way it charges for those services, spokesperson Marci Goldstein told KFF Health News.
The company, which reported bringing in $1.76 billion in 2025 from the part of its business that includes Medicaid work, expects that revenue to continue to grow, even as people fall off the Medicaid rolls, “because of the additional transactions that will need to take place,” David Mutryn, Maximus’ chief financial officer and treasurer, said during the earnings call.
Losing Medicaid health coverage isn’t just an inconvenience, since many people enrolled in the program probably don’t make enough money to pay for health care on their own and may not qualify for financial help for Affordable Care Act coverage, said Elizabeth Edwards, a senior attorney with the National Health Law Program.
People could be unable to afford medications or get essential care, which could lead to “devastating” health impacts, she said.
“The human stakes of this are people’s lives,” she said.
KFF correspondents Katheryn Houghton and Samantha Liss contributed to this report.
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism.
