Medicaid is about to lose millions of members. And many health plans are responding wrong.

New federal work requirements kick in January 2027. States must start outreach this summer.

18.5 million enrollees will be subject to the 80-hour monthly work requirement. CBO projects 5.2 million will lose coverage by 2034.

But here’s what should keep every plan leader up at night:
ℹ️ 69% of these members are ALREADY working or in school. Only 2% say they don’t want to work.
ℹ️ They won’t lose coverage because they’re not working. They’ll lose it because they can’t navigate the paperwork.

‼️ We’re about to disenroll millions of people – including those with diabetes, heart disease, and chronic pain – not because they don’t qualify, but because they didn’t get a letter. Or were working a double shift when the redetermination window closed.

A Yale/JAMA study found 40% of at-risk adults have 3+ chronic conditions. One in five take 5+ medications. These aren’t people who will just “figure it out.”

So what are most plans doing?

🤦‍♂️ Cutting budgets. Freezing vendor contracts. “Waiting to see what happens.”

That’s a mistake.

States must conduct member outreach between June 30 and August 31, 2026. That’s just 4 months away. The mandate: reach members by mail PLUS phone, text, or digital channels.

A letter in the mail isn’t going to cut it.

At Twig Health, we’ve seen this firsthand. When you meet Medicaid members where they are – a text from a nurse they know, a call from someone who cares – engagement transforms. Real nurses, guided by AI, building real relationships via SMS and phone. Not chatbots. Not robo-calls. Human connection at scale.

That’s what the next 12 months demand.

Our call to action for plan leaders:

✅ Don’t wait for 2027. Your members need to hear from you before they get a confusing government letter.
✅ Invest in engagement, not compliance. Plans that treat this as a checkbox will hemorrhage members. Those that build trust will retain them.
✅ Go digital-first. Your members are on their phones. They respond to texts. They don’t answer unknown numbers.
✅ Lead with nurses, not algorithms. AI should power outreach – not replace the human. Members with chronic conditions need someone who listens.

The Medicaid landscape is about to undergo its biggest disruption in a decade.

The question isn’t whether your members will be affected. It’s whether you’ll be the plan that helped them through it – or the one that let them fall through the cracks.

What’s your plan doing to prepare?