p>by Shalina Chatlani, West Virginia Watch
July 17, 2025

States must begin verifying millions of Medicaid enrollees’ monthly work status by the end of next year — a task some critics say states will have a hard time carrying out.

A provision in the tax and spending bill President Donald Trump signed into law July 4 will require the 40 states plus Washington, D.C., that have expanded Medicaid to check paperwork at least twice a year to ensure those enrollees are volunteering or working at least 80 hours a month or attending school at least half time.

The new law provides states $200 million for fiscal year 2026 to get their systems up and running. But some experts say states will have difficulty meeting the deadline with that funding and worry enrollees might lose their health benefits as a result.

A year and a half to comply is likely not going to be enough time for most states, especially since the federal government must craft guidance on how they should implement their programs, said Dr. Benjamin Sommers, a health economist at Harvard T.H. Chan School of Public Health. He predicted it will be difficult to create technology simple enough — such as a phone app — to streamline the process for all enrollees.

“Two hundred million [dollars] is not going to cover the 40 expansion states that we have,” he told Stateline. “There is not a silver bullet here, and there isn’t a single app out there that’s going to keep people who should be in Medicaid from losing coverage. That’s just not realistic.”

A spokesperson for the North Carolina Department of Health and Human Services, Hannah Jones, told Stateline that “it will take a significant amount of time and investment in order to implement work requirements.”

Jones said an estimated 255,000 people in North Carolina could lose coverage because of these requirements and their “administrative burden.”

“More automation reduces manual work on beneficiaries and eligibility case workers, but it requires more time, funding, and staff resources to implement,” Jones wrote in an email.

Emma Herrock, a spokesperson for the Louisiana Department of Health, wrote in an email that the vast majority of the state’s Medicaid enrollees already work, and the agency expects few people to be disenrolled. Herrock said the department will establish work verification systems by the end of 2026.

“The department is taking a thoughtful approach to implementation,” Herrock wrote. “We are already working with several Louisiana agencies … in order to receive data on recipients who are working.”

She added that the department views work requirements “as a means to grow our economy, while reinforcing the value of work and self-sufficiency.”

In New York, it could cost the state $500 million to administer the new requirements, New York Department of Health spokesperson Danielle De Souza wrote in an email.

Between 600,000 and 1.1 million individuals who are eligible for and enrolled in Medicaid could potentially lose coverage because of work reporting requirements, she wrote, based on what happened when states were required to resume checking eligibility after the COVID-19 health emergency ended.

“The department will remain steadfast in its commitment to protecting the health of all New Yorkers and will work to mitigate the impacts of this law,” De Souza wrote.

The new rules apply to states that expanded Medicaid to adults between the ages of 19 and 64 with incomes below 138% of the federal poverty line (about $22,000 for an individual), an option that was made available under the 2010 Affordable Care Act. More than 20 million people were enrolled through Medicaid expansion as of June 2024 — those are the patients who will face work requirements.

Reapplying for Medicaid, which typically has been required once a year, already is burdensome for some patients, said Dr. Bobby Mukkamala, president of the American Medical Association.

“On top of that, now we’re going to be challenging so many people who were at least able to deal with it financially with things like … proving that they got a job,” Mukkamala said in an interview.

Previous attempts at implementing work requirements have ended up costing states millions in administrative and consulting fees. And in some cases, people who were eligible for Medicaid lost their coverage due to paperwork issues.

Arkansas’ example

Several states wanted to implement work requirements during the first Trump administration. But only Arkansas fully did so, in 2018, before a federal judge halted the requirements. More than 18,000 Arkansas residents lost Medicaid coverage during the 10 months the requirements were in effect.

Sommers, of Harvard, noted that most people were disenrolled because they didn’t know about the policy or made paperwork errors, not because they weren’t working.

“Red tape led to people losing their coverage,” he said. “They had more trouble affording their medications. They were putting off needed care.”

Brian Blase, president of the Paragon Health Institute, a conservative policy group that advises congressional Republicans, said he thinks concerns about the new requirements are overblown because there’s more advanced technology now.

“Lots of government programs have initial implementation challenges,” Blase told Stateline. “Arkansas was seven years ago, and if you just think about the change in the technological advancements over the past seven years … we didn’t have artificial intelligence and just the ability of modern tech.”

As it stands, each state has varying technological capabilities, and will have a different timeline and budget, said Michael Heifetz, a managing director at consulting firm Alvarez & Marsal and a former Medicaid director in Wisconsin. His team contracts with states to implement Medicaid, including work requirements, and other programs.

He also noted that the Trump administration can give states a deadline extension on implementing work requirements to Dec. 31, 2028, if they show they are making a “good faith effort.” States will need to share data across agencies in new ways, he said.

“It will require some form of data sharing and communications with educational agencies, workforce training agencies and some other agencies that typically aren’t in the Medicaid ecosystem,” Heifetz said.

State governments may resist hiring full-time positions for those tasks, he said, but “artificial intelligence and other tools can help work through these processes in a smoother fashion.”

Other state efforts

Efforts in other states to implement work requirements have had mixed results.

In Georgia, for example, an experimental work requirement program cost taxpayers more than $86 million in its first 18 months but enrolled just 6,500 people during that time, according to an investigation by ProPublica and The Current published in February. That’s 75% fewer participants than the state had estimated for the program’s first year.

The nonpartisan U.S. Government Accountability Office in 2019 looked at five states that tested systems to track Medicaid work requirements under the first Trump administration. Those demonstration projects were rescinded during the Biden administration.

The states estimated their projected administrative costs for implementing work requirements for one to three years, and the total far surpassed the $200 million Congress has provided in the new law. Kentucky alone estimated $270 million, Wisconsin $70 million, Indiana $35 million, Arkansas $26 million and New Hampshire $6 million.

Susan Barnidge, an assistant director on the GAO health care team and an author of the report, said the agency found that across states there wasn’t much federal oversight of administrative costs on test programs. Oversight will be key as states roll out their work requirement systems, she said.

“We found some weaknesses in [federal] Centers for Medicare & Medicaid oversight of certain federal funding for certain administrative activities. So we found examples of things that states sought federal funding for that didn’t appear to be allowable,” Barnidge said in an interview. “I think that will remain relevant.”

Mukkamala, of the American Medical Association, said the burden will in some ways fall to doctors’ offices to help keep patients enrolled, as they work with patients to check eligibility and possibly help get them on Medicaid. He works in Flint, Michigan, as an otolaryngologist, or ear, nose and throat doctor, and said a third of his patients are on Medicaid.

“As if it’s easy to take care of their health care issue, given things like prior authorization,” Mukkamala told Stateline. “Now to add to the challenge, we have to figure out how to get them covered.”

Stateline reporter Shalina Chatlani can be reached at schatlani@stateline.org.

West Virginia Watch is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. West Virginia Watch maintains editorial independence. Contact Editor Leann Ray for questions: info@westvirginiawatch.com.

The post Tracking Medicaid patients’ work status may prove difficult for states appeared first on westvirginiawatch.com

Note: The following A.I. based commentary is not part of the original article, reproduced above, but is offered in the hopes that it will promote greater media literacy and critical thinking, by making any potential bias more visible to the reader –Staff Editor.

Political Bias Rating: Center-Left

The content critically examines the implementation of Medicaid work requirements, highlighting concerns about administrative burdens, potential loss of coverage for vulnerable populations, and the challenges states face in complying with new federal rules. It emphasizes perspectives from health economists and medical professionals who caution against the policy’s practical impacts, suggesting skepticism about the effectiveness and fairness of work requirements. While it includes some viewpoints supportive of the policy and technological optimism, the overall tone leans toward questioning the policy’s consequences and emphasizing the difficulties faced by Medicaid recipients, aligning it with a center-left perspective that generally favors expanding access to social safety net programs and is wary of restrictions that could reduce coverage.

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Pickup truck crashes into divider. For more Local News from WSAZ: https://www.wsaz.com/ For more YouTube Content: …

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by Lori Kersey, West Virginia Watch
July 14, 2025

As the number of U.S. measles continues at a record high, West Virginia Gov. Patrick Morrisey has not backed down from his January executive order loosening the state’s strong school vaccine laws by allowing religious and philosophical exemptions for the shots. 

At a news conference last month, Morrisey said his administration is not aware of “one shred of evidence” that the state allowing religious exemptions would have negative consequences on residents’ health. 

“We’re not aware of one shred of evidence that by moving to be a state that respects religious liberty and exemption, that there is any negative public health effect,” Morrisey said June 24. “I dare the other side to provide that. They’re misleading you. We’re going to tell the truth.”

The executive order is based on the 2023 “Equal Protection for Religion Act.” Lawmakers this year voted down Senate Bill 460, which would have set the religious exemptions in state code. Morrisey maintains that the religious freedom law should give families the freedom not to vaccinate their kids if they choose to; he says his January executive order is merely an interpretation of that law.

Morrisey told a reporter that statistics show that in states that allow religious exemptions, the number of people who get religious exemptions for vaccines is not big enough to affect herd immunity, the resistance to infectious disease a community with a high rate of vaccination has. 

But public health experts, including one of the state’s former health officers, disagree with the governor’s assertion. They say areas with looser school vaccine laws are more likely to have disease outbreaks.

“There is overwhelming evidence that vaccine exemption policies reduce vaccination coverage rates and increase the burden of vaccine-preventable diseases,” Richard Hughes, a George Washington University law professor and vaccine law expert, wrote in a statement to West Virginia Watch. He said Morrisey’s claim disregards “decades of public health research.”

Hughes pointed to a 2010 medical study in California that found that areas of high non-medical exemptions were 2.5 times more likely to have outbreaks of pertussis, also known as whooping cough, than those with lower non-medical exemptions.

Another analysis estimated that a state with easier nonmedical vaccine exemption procedures is nearly twice as likely to experience a measles outbreak compared with states with more difficult exemption policies.

“The public health evidence is clear: well-designed vaccine exemption policies can help protect child health by maintaining high immunization coverage, preventing outbreaks, and protecting vulnerable children who cannot be vaccinated for valid medical reasons,” Hughes said. 

“This is not just about religious liberty. It’s about whether one official can unilaterally weaken a system that has long protected the health of all children in the state,” Hughes said. 

West Virginia currently does not have a health officer. State Secretary of Health Arvin Singh appeared at the governor’s news conference and spoke in support of religious exemptions. Singh said that the executive order “ensures that people of faith are not punished for making personal, prayerful decisions about their children’s health.”

Singh, who has a Master of Science in health care leadership and a master’s degree in public health, said there’s not “meaningful evidence,” religious exemptions have led to an increase in disease incidence at the population level. 

He pointed to Florida, Ohio and Pennsylvania as states that maintain 90% rates for school vaccinations while allowing religious exemptions. 

Data from the Ohio Department of Health indicate that 86% of kindergarten kids got all their required shots in the 2023-2024 school year. In Florida, that number was 88% in the 2023 school year. Pennsylvania kindergarteners had a 94% vaccination rate for measles during the 2024-2025 school year.

A spokeswoman for the state Department of Health said Singh was referring to the Centers for Disease Control and Prevention’s elementary school data and clarified that he meant that Ohio and Florida were “nearly at the 90% immunization rate threshold.”

“West Virginia is a beautiful state filled with hard-working families who love their children, live their values and seek to do what’s right,” Singh said. “We should not be one of the only five states still denying parents their God-given right to make decisions of conscience.”

More than 140 non-medical exemptions approved so far 

All states require school students to be vaccinated against a series of infectious diseases. West Virginia has been one of only five in the country that do not allow religious or philosophical exemptions to those vaccines. 

As of last month, the state Department of Health said it had processed 140 religious exemptions for the 2025-2026 school year under Morrisey’s executive order. At 140, the number of exemptions would still be a tiny fraction of the total number of school age children in the state, estimated at more than 250,000.

By contrast, there were 53 requests for medical exemptions to school vaccine requirements made in 2023 — and only nine of those resulted in a permanent exemption. 

Dr. Steven Eshenaur, health officer and executive director of the Kanawha-Charleston Health Department, said Morrisey’s belief that non-medical exemptions will not affect the state’s herd immunity is just an assumption. He and other experts have pointed to the state’s low rate for preschool vaccinations as evidence that many parents wouldn’t have their children vaccinated unless they’re required to. 

According to 2021 data, the state has some of the lowest vaccination rates in the country for children who are below school age. That year, about 57% of West Virginia three-year-olds got all of the recommended vaccinations. In 2023, 74% of West Virginia’s young children were vaccinated, according to KFF.

However, 98% of the state’s kindergarten children were vaccinated for measles during the 2023-2024 school year — higher than the national average of about 93%. Health experts say the state’s school vaccination laws are the reason for the higher rate of kindergarten vaccination. 

“West Virginia has one of the lowest preschool immunization rates in the country,” Eshenaur said. “If those parents don’t have to immunize their children [to enter kindergarten], we would be looking at a very large percentage of our children that are unimmunized or under immunized going into school.

“The assumption is that they will get immunized,” Eshenaur said. “The reality is that parents aren’t immunizing them now. So why would they if they don’t have to?”

Eshenaur, pointed to measles outbreaks in Ontario, Canada and in Texas, both of which allow religious exemptions. As of July 8, Texas reported 753 confirmed measles cases and two fatalities since late January. The Ontario outbreak has infected more than 2,000 people and killed an infant. Most of the cases are in those who are unvaccinated. 

‘You can’t look at just the statewide rate’

According to the CDC, as of last week, the U.S. reported 1,288 measles cases this year, the highest number in 33 years. 

West Virginia last year reported its first confirmed measles case in 15 years. Health experts at the time credited the state’s high vaccination rates as the reason the highly-infectious virus did not spread to others. 

“We know that when a number of children utilize a religious exemption, that it does set up that particular community or area or higher risk of a measles outbreak in particular, given how infectious it is, and we have witnessed that over this past year right here in the United States,” Eshenaur said. 

Dr. Cathy Slemp, who was the state health officer from 2002 to 2011 and again from 2018 to 2020, said the more nonmedical exemptions that are present in a community, the higher the risk of disease and outbreak, among the unvaccinated and in the broader community. 

  “… in general, the laxer the (nonmedical exemption) process, the more exemptions seen and the greater the disease risk,” she said. 

“Even a few cases or a single preventable outbreak have public health impact to those families and to public health and health care system costs of investigation and care,” Slemp said.

Nonmedical exemptions tend to cluster, Slemp said. One town or one school may have a high number of exemptions, leading to pockets of the population that have lower vaccination rates.

“You can’t look at just the statewide rate,” Slemp said. “It would really depend on that community and that school to look at the rates. So when we just look at a statewide rate, it doesn’t tell us the risk of individual communities.”

The vaccination rate needed to achieve “herd immunity” varies by disease. Herd immunity for measles, for instance, requires a 95% vaccination rate.

Morrisey’s comments came during a news conference announcing his support of a lawsuit filed in Raleigh County against the West Virginia Board of Education. The board voted to defy the governor’s executive order and instruct county boards of education to allow only medical exemptions to vaccine requirements.  

Slemp said the issue isn’t about having no evidence, but a question of what a society values.

“It’s a societal question of what freedoms we value most — individual parental choice or societal comfort knowing we’ve done the best we can to protect all, especially infants and others who don’t have the option of being protected by vaccines,” she said.  “We’re not looking at a return to prevaccine day levels of disease, but we can’t say there’s no impact. “

West Virginia Watch is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. West Virginia Watch maintains editorial independence. Contact Editor Leann Ray for questions: info@westvirginiawatch.com.

The post Morrisey says WV health won’t suffer with weakened vaccine laws. Experts disagree. appeared first on westvirginiawatch.com

Note: The following A.I. based commentary is not part of the original article, reproduced above, but is offered in the hopes that it will promote greater media literacy and critical thinking, by making any potential bias more visible to the reader –Staff Editor.

Political Bias Rating: Center-Left

The article presents a perspective that is generally aligned with public health advocacy, emphasizing the risks of loosening vaccine mandates and highlighting expert opinions that challenge the governor’s support for religious exemptions. The language is critical of the executive order’s potential impact on community health, reflecting a bias favoring science-based vaccination policies and collective welfare over individual exemptions framed as religious liberty. While it reports the governor’s position fairly, the overall framing leans toward concern about public health consequences, a stance typically associated with center-left viewpoints that prioritize government intervention in health matters.