Officials show little evidence that the new technology will help Medicaid enrollees meet work rules

This summer, Louisiana sent a text message to just over 13,000 people enrolled in its Medicaid program, with a link to a website where they could confirm their entry.

The texts were part of a pilot to test technology that the Trump administration says will make it easier for some Medicaid enrollees to prove they meet new requirements — working, studying, job training or volunteering at least 80 hours a month — that are scheduled to take effect in just over a year.

But only 894 people completed the quarterly wage check, or just under 7% of the enrollees who got the script, according to Drew Maranto, Louisiana’s undersecretary of health.

“We’re hoping to get more sign-ups,” Maranto said. “We plan to raise awareness.”

Time is ticking for officials in 42 states — excluding those that never expanded Medicaid — and in Washington, D.C., to figure out how to verify that the estimated 18.5 million Medicaid enrollees meet rules included in President Donald Trump’s tax and spending law. They have until the end of next year, and federal officials are giving those jurisdictions a total of $200 million to do so.

The policy change is one of several aimed at freeing up money for Trump’s priorities, such as increased border security and tax breaks that mainly benefit the wealthy.

The nonpartisan Congressional Budget Office said Business rules will be the main reason Millions of people will not be able to obtain health insurance over the next decade. It estimates that changes to Medicaid will result in 10 million fewer Americans by 2034 — more than half of them because of eligibility rules.

Currently, state officials, health policy researchers and consumer advocates are monitoring the pilot program in Louisiana and another in Arizona. Mehmet Ozdirector of the Centers for Medicare and Medicaid Services, promoted these drive-thru tests and said they would allow people to check their entry “within seven minutes.”

“There have been efforts to do this in the past, but they couldn’t achieve what we can achieve because we have the technologies now,” Oz said. During a television appearance In August.

Brian Blase, president of the conservative Paragon Health Institute and a chief architect of the Medicaid changes in the new law, weighed in during a conference The last appearance of radio With artificial intelligence today, “people should be able to seamlessly integrate into the way they spend their time.”

KFF Health News found little evidence to support such claims. Federal and state officials provided little information about the new technology the pilots tested. They say, however, that it connects directly to the websites of payroll providers for Medicaid enrollees, rather than using artificial intelligence to draw inferences about their activities.

The Trump administration’s efforts began “as soon as the bill was signed” in July, Oz said. But working on pilot programs It began during the Biden administration.

Medicaid is a federal-state program: the federal government contributes most of the money, but the management of these funds is up to the states, not the federal government.

“Oz can say, ‘Oh no, we’ll fix this.’ We’ll do it.’ Well, they’re not actually running the program Joan Alkera health policy researcher at the Georgetown Center for Children and Families.

Officials also provided few details about the pilots’ effectiveness in helping those enrolled in Medicaid or other public benefit programs.

The lack of information has some state officials and health policy researchers concerned that the Trump administration lacks workable solutions to help states implement the work rules. As a result, they say, people who have a legal right to Medicaid benefits may lose access to them.

“What keeps me up at night is the fear that members who qualify for Medicaid and are trying to access health care services will fail and lose coverage,” said Emma Sandow, Oregon’s Medicaid director.

Officials involved in the Louisiana and Arizona projects declined to answer many specific questions about their efforts, instead directing KFF Health News to federal officials.

Spokespeople for the Arizona Departments of Medicaid and Economic Security — Johnny Cordoba and Brett Pizio, respectively — did not share data on how many people participated in the state’s pilot testing nor describe the outcome. They said the pilot program was used only to verify eligibility for the federal Supplemental Nutrition Assistance Program, which is a smaller program than Medicaid.

the Community Food Bank of Southern Arizonaa nonprofit that helps people sign up for SNAP benefits, hasn’t heard about the pilot program.

State officials and health policy researchers said none of the pilot programs can confirm whether a person meets other qualifying activities — such as community service — or any of several exemptions. Only backtested tools can verify income.

The digital tools officials aim to share with states are “largely in development,” Andrew Nixon, communications director for the U.S. Department of Health and Human Services, which oversees the OZ agency, wrote in a statement.

One person Do this development He is Michael Boorstin, a software engineer who until recently worked for the US Digital Service, which later became known as the Government Efficiency Administration.

When the US Digital Service turned into DOGE, Boorstin and other employees left and started a non-profit called DOGE Digital Public Works To end support for technology to make it easier for people to verify their income to enroll in Medicaid.

But without getting permission from state officials, Boorstin wouldn’t describe the tool in development, other than to say it’s mobile-first, can quickly verify income for a new or returning customer, “and we’re very happy with it.”

State agencies that administer benefits programs, such as Medicaid and SNAP, are understaffed and use different eligibility systems. Many of them need updatingImproving it is a “difficult task,” he said.

The $200 million startup costs the federal government has allocated for business requirements tracking systems are on par Almost four times the cost of it To administer Georgia’s Medicaid work requirements program alone.

That state, which has the only active work requirements program in the country, called Georgia Pathways to Coverage, was granted coverage in September Temporary extensionalthough A Latest report From a federal watchdog that says it has not received enough federal oversight. A Complex registration process It has kept the program’s enrollment well below Georgia’s own expectations.

Trump’s tax and spending law allows states to request additional time — until the end of 2028 — to begin enforcing the rules, but only with the approval of Health and Human Services Secretary Robert F. Kennedy Jr. It also allows counties that have Excluding high unemployment ratesBut states must apply for this exemption.

Even with an app that states could use to prove people are eligible for Medicaid, enrollees would still need to know the app exists and how to use it — something that’s not a given, Alker said. There’s also no guarantee they’ll have reliable cell service or internet access. like KFF Health News reportedMillions of Americans live in rural areas without reliable internet.

Private vendors are also working on such applications, he said Jennifer Wagnerwhich examines Medicaid eligibility and enrollment for the Center on Budget and Policy Priorities. Wagner said she has seen several vendors displaying products they plan to take to states for business rules. Many of them are limited in scope, such as those in pilot tests, she said.

“No one has a silver bullet that will ensure that eligible people won’t lose coverage,” she said.