Katie Crouch, a 48-year-old Delaware resident, spent months navigating her state's Medicaid system to confirm her health coverage renewal. Her struggles highlight broader administrative challenges facing state agencies as new federal mandates take effect, according to health policy researchers. These changes could impact millions of low-income individuals.
Katie Crouch, a 48-year-old Delaware resident, experienced considerable difficulty while seeking information about her Medicaid benefits. She reported calls ringing unanswered or connecting to voicemails that disconnected. Crouch also described transfers that ended calls and instances of connecting to an empty line. She spent several months attempting to confirm her Medicaid coverage renewal. By late March, she had not received reapproval for the state-federal health program. Crouch, who experienced a brain aneurysm a decade ago, also holds Medicare. Medicaid had previously covered her $200 monthly Medicare deductibles. For three months, she paid these costs herself, straining her family's limited income. Her situation reflects broader issues within state Medicaid call centers, where staffing shortages hinder benefit access, health policy researchers state. After contacting the office of U.S. Representative Sarah McBride, Crouch finally received an update. She learned she did not qualify for Medicaid, a fact she said had not emerged in two years of prior interactions with the state. Delaware's Medicaid agency did not respond to requests for comment regarding Crouch's specific case. State agencies will require more staff to implement these new federal rules, according to KFF Health News outreach. Jennifer Wagner, who directs Medicaid eligibility and enrollment at the Center on Budget and Policy Priorities, stated that states are "struggling significantly." Wagner, a former associate director for the Illinois Department of Human Services, added that "significant additional challenges" will arise from these changes. Republicans supporting the Medicaid changes, effective January 1, 2027, contend the rules will encourage enrollees to find employment. However, research on prior Medicaid work requirement programs has shown little evidence of increased job acquisition. Sophia Tripoli, senior director of policy at Families USA, a consumer advocacy group, described the new rules as involving "a much larger scale of administrative complexity." Tricia Brooks, a researcher at the Georgetown University Center for Children and Families, noted that these jobs require months of training, can be emotionally challenging, and typically offer low pay. She stated that workers "get yelled at a lot" due to enrollee frustration. A new federal law, the One Big Beautiful Bill Act, signed by President Donald Trump last summer, will soon increase demands on state agency personnel. This legislation mandates new work requirements and requires eligibility verification every six months, rather than annually. These changes are expected to reduce Medicaid spending by nearly $1 trillion over eight years. The Congressional Budget Office estimated that the rules could lead over 5 million people to lose health coverage by 2034. Many states currently lack sufficient staff to process Medicaid applications or renewals promptly. The Centers for Medicare & Medicaid Services (CMS) monitors states' ability to handle most applications within 45 days. In December, approximately 30 percent of Medicaid and Children's Health Insurance Program applications in Washington, D.C., and Georgia exceeded this 45-day period. More than one-quarter of applications in Wyoming also missed the deadline. Maine saw one in five applications processed beyond 45 days. CMS began publicizing state Medicaid call center data in 2023, revealing a strained system, researchers and consumer advocates reported. December call wait times included over three hours in Hawaii and more than an hour in Nevada. In 2023, state Medicaid agencies initiated a process to re-evaluate enrollee eligibility after pandemic protections ended. This "unwinding" process resulted in over 25 million individuals losing their benefits. The new work rules will necessitate extensive IT system modifications and new training for eligibility workers. Government contractor Maximus, which supports eligibility in 17 states, expects revenue growth from increased transaction volume, according to CFO David Mutryn. The new Medicaid rules will take effect in most states on January 1, 2027. Several states anticipate needing additional personnel to manage the increased workload. Idaho has 40 eligibility worker vacancies, while New York estimates needing 80 new employees, costing $6.2 million. Pennsylvania reports nearly 400 open positions in county human services offices. Indiana's Medicaid agency has 94 open positions. Maine wants to hire 90 additional staffers, and Massachusetts seeks 70 more. Montana plans to implement the rules starting July 1, despite existing system backlogs. Missouri's social services agency cut 1,000 frontline workers over a decade, according to director Jessica Bax.