7.6 Million Americans Could Lose Medicaid Under the Big Beautiful Bill: Work Requirements, State Timeline, and What to Do Now

# 7.6 Million Americans Could Lose Medicaid Under the Big Beautiful Bill: Work Requirements, State Timeline, and What to Do Now

> **Quick answer:** The One Big Beautiful Bill Act (OBBBA), signed July 4, 2025, requires Medicaid expansion adults ages 19-64 to document 80 hours per month of work or qualifying activity to keep coverage. A February 2026 RAND Corporation study projects 7.6 million Americans will be off Medicaid by 2034 — with work requirements alone driving 5.3 million of those losses. Nebraska is already enforcing as of May 1, 2026. Montana enforces July 1. Most states begin January 1, 2027. Your state's choices about exemptions and verification frequency will determine whether you're at risk — and those choices vary dramatically.

> **This article is for informational purposes only and does not constitute legal, medical, or financial advice. For guidance specific to your situation, contact your state Medicaid agency, a certified enrollment navigator, or a qualified attorney.**

The 7.6 million number has been reported. What hasn't been reported clearly is that this number is not a 2027 problem — it is a 2026 problem that is already unfolding, state by state, with wildly different rules depending on where you live. Nebraska enforced first. Montana is weeks away. And a new KFF survey of state Medicaid agencies reveals that two states — Indiana and Iowa — have chosen to offer zero optional hardship exemptions beyond what federal law requires. Understanding where your state stands right now is the most important thing you can do if you or someone you love relies on Medicaid for health coverage.

This article is a companion piece to our reporting on [27 million Americans already uninsured in 2026](https://fizzty.com/article/news-27-million-uninsured-americans-2026-aca-subsidy-collapse) after ACA subsidies collapsed and [workers opting out of employer health insurance](https://fizzty.com/article/news-workers-opting-out-employer-health-insurance-2026) as premiums hit $27,000 per year. The Medicaid cuts are not a separate crisis. They are the third wave.

## The 7.6 Million Projection: Where the Number Comes From