JAMA Health Forum Conversations The Year We Lost Medicaid
Apr 10, 2026
Heidi Allen, Columbia School of Social Work professor and Medicaid scholar, discusses looming policy shifts that could reshape coverage for millions. She outlines funding pressures, risks to long-term care and rural hospitals, the aftermath of continuous coverage unwinding, and lessons from the Oregon Health Insurance Experiment. She also considers postpartum coverage, work requirements, and the potential of tech and policy fixes.
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Medicaid Under Budget Pressure From Cuts And Economy
- Medicaid will face greater strain as the economy weakens and proposed federal cuts force states to do more with less.
- Heidi Allen notes states must avoid deficits, so they'll likely trim optional populations and services, especially after H.R. 1's funding changes.
Coverage Churn Harms Care And Finances
- Coverage churn disrupts care and worsens health and finances for low-income families during gaps in Medicaid coverage.
- During unwinding many states improved processes like using government data for income verification to reduce administrative burden.
Work Requirements Fail To Raise Employment
- Work requirements for expansion populations have not increased employment in studies and often confuse enrollees.
- Allen cites Arkansas where many didn't even realize work requirements existed and most expansion enrollees already work or are exempt.
