Who loses Medicaid in 2027

You already know which patients are on Medicaid. The new work requirement does not test that. It tests whether a patient can prove their status in time, and most of the coverage lost last time was paperwork, not eligibility.

You do not need a chart flag to tell you which of your patients are on Medicaid. You already know. What is harder to know, for any one patient, is whether they will still be covered on January 2, 2027, and whether the reason they might not be has anything to do with whether they actually qualify.

Starting January 1, 2027, adults enrolled through the Affordable Care Act (ACA) Medicaid expansion group, ages 19 to 64, must complete at least 80 hours a month of work, job training, or community service to keep their coverage. The requirement comes from the One Big Beautiful Bill Act (OBBBA), signed July 4, 2025, and reaches roughly 20 million people already enrolled nationally. Three groups are exempt: parents and caretakers of children age 13 or under, pregnant and postpartum patients, and anyone the state classifies as medically frail, a category that explicitly includes disability, substance use disorder (SUD), and other serious or complex medical conditions. States check compliance twice: once when a person applies or re-enrolls, looking back one to three months, and again at every redetermination, at least every six months.

The state does not need to find someone ineligible to remove them from Medicaid. It only needs them to miss a form. During the 2023 to 2024 unwinding, when states resumed normal eligibility checks after three years of pandemic-era continuous coverage, 25 million people lost Medicaid. The Government Accountability Office (GAO) found that 69% of those disenrollments were procedural: a renewal notice mailed to an old address, a form that never came back, a deadline missed, not a determination that the person no longer qualified. Work-requirement compliance adds a second form to miss. A patient can be fully exempt as medically frail and still lose coverage simply because nobody submitted the paperwork proving it.

A state eligibility system does not know a patient's diagnosis. A treating clinician does. The patients worth watching are the ones in the expansion age band, 19 to 64, whose chart does not already show one of the exemption categories: no documented disabling condition, no SUD diagnosis on file, no young dependent noted, not currently pregnant or postpartum. That is not a judgment about whether a patient is disabled or exempt. Plenty of exempt patients simply have not had a reason to document it yet. It is a judgment about who is most likely to be asked, by the state, to prove something nobody has organized proof of yet.

A practice does not need new software to start. This quarter: pull the list of Medicaid patients ages 19 to 64. Cross it against whoever already has a disability, SUD, or serious medical condition documented, since that group likely already qualifies for the medically frail exemption on paper. For everyone left, that is the priority list. Confirm their current address and phone number on file, since redetermination notices go out by mail and a returned envelope is exactly how a procedural disenrollment starts. And flag anyone whose clinical picture might support an exemption so the documentation exists before the state asks for it, not after.

JotPsych keeps patient, payer, and note data in one record, so pulling that list is a filter, not a spreadsheet project built from scratch.