Your Voice Matters: The time is right to tell your state leaders to build Medicaid work requirement systems that use the medical records that already exist, so people with chronic conditions don't lose coverage they qualify for.
Starting in January 2027, many adults on Medicaid will have to show they work, volunteer, or go to school for a set number of hours each month. People with serious health conditions can qualify for an exemption.
But how people prove they qualify is up to each state. And states are deciding that right now.
Here's what the difference looks like.
Meet Dana
Dana is 44. She has chronic kidney disease. She isn't on dialysis, but her kidneys work at less than half their normal level. She sees a kidney specialist every few months and gets regular blood tests. All of it is in her medical records.
Most days, Dana gets by. She works part time when she can. But she gets tired fast, and some weeks she can barely get through the day. On paper, she can look "fine." In real life, she's living right on the edge. Overall, though, steady access to specialists and medication allows her to work as much as she can, and avoid more serious kidney failure.
In State A, the system checks the records it already has. It sees Dana's diagnosis, her specialist visits, and her lab results. It marks her as exempt. When her renewal comes up, the system checks again on its own. Dana gets a letter telling her she's still covered. She doesn't have to do anything.
In State B, the rules are narrow. Only people on dialysis count as "medically frail." Dana doesn't qualify, so she has to prove she's working enough hours each month. During a bad stretch, she falls short. She gets a letter asking for paperwork. Her doctor could explain her condition, but State B doesn't accept a doctor's note as proof. The deadline passes. Dana loses her coverage, even though she's sick enough that she should be exempt.
Now she has to start over, without the specialist visits and medicine that help keep her kidneys from getting worse.
Same patient. Same diagnosis. Two very different outcomes. The only thing that changed was how the system was built.
Why this matters now
States are building these systems now, since the requirements must be in place in January 2027. Once they're built, states will keep updating them and paying for changes for years to come. The choices made today will shape what happens to patients like Dana for a long time.
The good news: most of the information states need already exists. Diagnosis and treatment records can do most of the work, if states let them.
The risk: when people have to prove the same thing again and again, or when the rules for who counts as "medically frail" are too narrow, people lose coverage they should keep. And not everyone has easy access to a computer, a printer, or a doctor who can fill out forms quickly.
What we're asking states to do
We're asking state leaders to build a system that:
- Uses existing medical records first, instead of making people re-prove what's already documented
- Takes patients at their word when they describe their own condition
- Defines "medically frail" broadly, so it includes the people who need the exemption
- Limits how often people have to re-verify, with automatic renewal when it makes sense
- Starts with the easiest data before asking for anything more
- Offers real help for people without easy online or paperwork access
- Lets a doctor's note count as a direct path to an exemption
Patients already carry enough
People with chronic conditions spend hours every week managing their health: appointments, refills, insurance calls, bad days. Paperwork shouldn't be one more thing standing between them and the care they qualify for.
You can help. Send a message to your state leaders. Ask them to lighten the load on patients and build a system that uses the data we already have.