Minimizing H.R.1-related Medicaid coverage disruptions for high-risk patients.

Forthcoming H.R.1 Medicaid eligibility changes requiring documentation of work, school, or volunteer activities are projected to result in significant disenrollment. High-risk beneficiaries, including those experiencing homelessness, are more likely to experience barriers in navigating the eligibility process, such as qualifying for work requirement exemptions. We utilized an existing set of linked data across the medical safety net, state Medicaid agency, housing services providers, and justice agencies as a case study to understand the prevalence of select potential medical and social exemptions from work requirements, examine safety net system utilization to identify potential touch points to prevent coverage loss, and estimate medical costs to inform planning and resourcing efforts to support continued enrollment. We found a high prevalence of Medicaid members potentially exempt from work requirements and of interactions with the medical safety net and with housing service providers specifically within the group experiencing homelessness. Increased medical costs that would likely shift to the safety net if coverage loss occurred demonstrate an opportunity for community efforts to support enrollment. Our case study can serve as a model for other communities proactively to plan for the local impact of H.R.1 eligibility changes, including data integration, coordination, and support efforts.