New Medicaid Rules in Kentucky Could Cause Thousands to Lose Coverage

New Medicaid Rules in Kentucky Could Cause Thousands to Lose Coverage

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Thousands of Kentuckians face the loss of health insurance as new federal and state mandates tighten eligibility requirements for the state’s largest health program.

The $22 billion-a-year Medicaid program, which covers 1.3 million people including 600,000 children, is undergoing structural changes, Kentucky Lantern reported. These shifts target many of the 450,000 adults aged 19 to 64 who gained coverage through the 2014 Affordable Care Act expansion.

“I think the unfortunate reality is that it will catch people off guard,” said Dr. Steven Stack, secretary of the Cabinet for Health and Family Services, which oversees Medicaid in Kentucky.

The upcoming rules require most adults in that age bracket to prove they are working, attending school, or volunteering for at least 80 hours a month. While a grace period allows for self-reporting through 2027, the window for error closes permanently in 2028.

Strict documentation requirements approach

The transition begins on Jan. 1, 2027, when the state will allow beneficiaries to “attest,” or self-report, that they meet the new activity requirements. However, this leniency is temporary. By Jan. 1, 2028, the state will require hard documentation to verify employment, income, or school enrollment.

State officials anticipate that many will lose coverage not because they are ineligible, but because the administrative burden of proving compliance becomes too heavy. Dr. Stack said that the state intends to use existing data, such as tax filings and university records, to assist with verification, but he expects significant fallout.

“Come Jan. 1, 2028, we are going to have to have all these systems operational and if people can’t demonstrate compliance, they unfortunately and very sadly are going to lose Medicaid benefits,” Stack said.

The scale of the potential impact extends beyond state lines. A study by the Robert Wood Johnson Foundation suggests that between 5 and 10 million people nationwide could lose Medicaid coverage by 2028 due to these types of changes. In Kentucky, officials estimate “tens of thousands” may face similar outcomes.

The legislative drivers behind these shifts are twofold. At the federal level, the Trump Administration’s “One Big Beautiful Bill” (HR 1 of 2025) is estimated to reduce Medicaid spending by more than $900 billion over a decade. Locally, the Republican-controlled Kentucky General Assembly passed House Bill 2, which introduced small copays for certain services and tightened the reporting requirements for work and school.

The human and economic stakes

For those who rely on the expansion, the stakes are often a matter of survival. Cara Ellis, a 39-year-old Pikeville native and student at Morehead State University, credits the program with saving her life following a 2019 thyroid cancer diagnosis.

Despite currently meeting the requirements through her work and full-time studies, Ellis expressed deep anxiety over the looming paperwork mandates. “I think a lot of people are going to lose coverage,” Ellis told Kentucky Lantern. “I think we’re going to see a lot of people across the state like me – who got health coverage for the first time – are going to lose coverage.”

The debate over the program’s direction highlights a fundamental disagreement over fiscal sustainability versus public health stability. Supporters of the changes point to the rapid growth of the program’s budget. Rep. Ken Fleming, R-Louisville, previously argued that the Medicaid budget had more than doubled over the last five years, reaching an “unsustainable level.”

Conversely, Democrats have characterized the program as a vital safety net. During recent listening sessions held in cities like Louisville and Lexington, lawmakers heard concerns that the program serves as a stabilizing force for families. Rep. Lindsey Burke, D-Lexington, noted the program’s role in supporting everything from childbirth to end-of-life care.

The following table outlines the primary changes affecting the expansion population:

Requirement Category Current Status Starting Jan. 1, 2027 Starting Jan. 1, 2028
Activity Proof Standard eligibility Self-attestation allowed Mandatory documentation
Recertification Annual review Every six months Every six months
Work/School Hours Varies 80 hours/month minimum 80 hours/month minimum

While many adults face these hurdles, certain groups remain largely unaffected. This includes the nearly 900,000 Kentuckians enrolled in “traditional” Medicaid, such as pregnant women, people with disabilities, the elderly in nursing homes, and those living below 100% of the federal poverty level.

Even within protected programs, new rules are creating friction. Cheri Kulik, an Oldham County mother, said that families on the waiting list for the Michelle P. Waiver—a program for individuals with physical or intellectual disabilities—must now re-verify eligibility annually to keep their place on the list.

“If you’re on that list and you miss this form you have to send back, they can take you off,” Kulik told Kentucky Lantern.

As the 2027 implementation date approaches, the Beshear administration says it is working to notify as many people as possible to prevent accidental coverage gaps. However, the complexity of the new rules remains a primary concern for both providers and patients.

“I don’t know if we’ve seen the worst of what’s going to happen,” Kulik said.

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