Katie Crouch expressed that reaching out to her state’s Medicaid agency often leads to frustration, resembling a journey of dead ends.
“Initially, it just keeps ringing,” recalled a 48-year-old from Delaware. “The next time, I get an answering machine.” He noted that sometimes calls get transferred, only to hang up, and at other times, no one picks up after the phone rings.
She spent months trying to verify whether her Medicaid coverage had been renewed. By the end of March, she had not received the reauthorization for the year under the state’s federal program meant for low-income and disabled individuals.
Crouch, who endured a serious brain aneurysm a decade ago, also relies on Medicare, which serves those over 65 or with disabilities. Medicaid had been covering her $200 monthly Medicare deductible, but the strain on her family’s limited income had become noticeable over the last three months.
Her difficulties with Delaware’s Medicaid call center seem to be a common issue. State Medicaid agencies are currently stretched thin, struggling to provide adequate support for enrollment and to respond to inquiries about existing benefits. Research in health policy has indicated that a deficit of staffing could hinder people from fully accessing their entitlements.
Recently enacted, the Congressional Republicans’ One Big Beautiful Bill Act, signed by President Trump last summer, will soon impose additional demands on state agency employees, especially in regions where Medicaid has been expanded to include more low-income adults—this covers nearly every state and the District of Columbia.
The law forecasts an approximate $1 trillion reduction in Medicaid costs over the next eight years, with officials now required to frequently assess whether millions of enrollees meet new work requirements and reassess their eligibility every six months instead of annually.
KFF Health News approached various governmental organizations obligated to adhere to labor regulations, many of which expressed the need for extra staff to manage these changes.
This mandate could further stretch a workforce already under pressure, making it tougher for individuals like Crouch to obtain the basic assistance they need. Consumer advocates and health policy experts have warned that many might miss out on legally available benefits, drawing from their own experiences in state agencies.
“States are really having a tough time,” noted Jennifer Wagner, director of Medicaid eligibility at the Center on Budget and Policy Priorities, and a former deputy director at the Illinois Department of Human Services. “These modifications will pose even more challenges.”
Long wait times before seeking help
Republicans argue that the upcoming changes to Medicaid, set to take effect in most states on January 1, 2027, will assist enrollees in finding employment. However, research from other Medicaid work requirement programs has provided little evidence supporting such claims.
The Congressional Budget Office indicated that by 2034, the loss of health insurance will be the most significant impact of the Republican budget plan, with over 5 million individuals expected to be affected next year.
Advocates for consumers and researchers assert that many states currently lack the personnel needed for the swift processing of Medicaid applications and renewals.
The Centers for Medicare and Medicaid Services monitors whether states are able to handle common benefit claims within a 45-day timeframe.
In December, both Washington, DC and Georgia made up about 30% of total Medicaid and Children’s Health Insurance Program (CHIP) applications, with processing times exceeding 45 days. In Wyoming, over a quarter of applications experienced similar delays, while in Maine, one in five missed the deadline.
This year, CMS is set to start publicly sharing data from state Medicaid call centers, aiming to clarify the existing system, as highlighted by both researchers and consumer advocate groups.
In December, the wait times for phone assistance exceeded three hours in Hawaii, approaching an hour in Oklahoma, and over an hour in Nevada.
As of 2023, state Medicaid agencies commenced the process of determining whether enrollees who were protected during the pandemic still qualify for coverage. This “Medicaid rewind” didn’t work effectively in numerous states, resulting in over 25 million losing coverage.
Experts in health policy and advocates say that implementing new Medicaid rules will be especially daunting. These work regulations will necessitate significant changes in IT systems and employee training within a tightly defined timeline.
“This entails a much larger scale of administrative complexity,” remarked Sophia Tripoli from Families USA, a health care advocacy group.
After a prolonged period of trying to get assistance, Crouch finally had her questions addressed following a letter to Rep. Sarah McBride’s office. She reported that McBride’s team reached out to the state Medicaid agency, which eventually resulted in a follow-up call.
Ultimately, Crouch did not qualify for Medicaid, stating that in her two years of working with the government, this outcome had not been anticipated.
She commented that it “just doesn’t make sense” that the state agency was unaware of her ineligibility.
The Delaware Medicaid agency did not respond to inquiries regarding Crouch’s case.
States with Medicaid staffing shortages
In late March, several states informed KFF Health News that they would require additional personnel to successfully implement the new work requirements.
Idaho reported needing to fill 40 positions, while New York City projected an additional 80 staff members would be critical for managing the increased administrative load at a cost of $6.2 million. Pennsylvania noted nearly 400 job openings in county welfare offices, with Indiana mentioning 94 available positions at its Medicaid Agency. Maine aims to recruit 90 more staff, while Massachusetts is looking to hire 70 additional employees.
As of early March, Montana had filled 39 out of the 59 expected positions that officials deemed necessary. Despite ongoing backlogs, the state aims to roll out the new rules by July 1.
Missouri’s Human Services Agency has reduced its workforce, boasting about 1,000 fewer front-line employees than a decade ago, while the Medicaid and SNAP enrollment has more than doubled, according to its director, Jessica Backes.
Backes remarked that the department had initially believed updating the qualification system would enhance efficiency, though many anticipated improvements never materialized.
Tricia Brooks from Georgetown University’s Center for Children and Families pointed out that finding qualified candidates willing to take these jobs could be challenging. The positions typically require extensive training, tend to be mentally taxing, and generally offer low pay.
“They frequently deal with upset callers,” Brooks, a former head of New Hampshire’s Medicaid and CHIP customer support, mentioned. “People are upset, worried—some are even crying. They fear losing access to healthcare. So yes, helping someone can be quite tough sometimes.”
The state has turned to hiring government contractors, investing millions to ensure compliance with new federal laws.
Maximus, a contractor providing eligibility support and operating call centers in 17 states with Medicaid expansion, serves nearly three out of five individuals enrolled in the program nationwide.
During a recent earnings talk, Maximus executives noted that the company can invoice participants based on completed transactions, regardless of overall enrollment numbers in state Medicaid programs.
Maximus does not provide a standardized service model or billing approach, as explained by spokeswoman Marci Goldstein.
The company reported a revenue of $1.76 billion in 2025 from various sectors, including its Medicaid operations, and anticipates continuous growth, despite a potential decrease in enrollments.
Elizabeth Edwards, an attorney with the National Health Law Program, emphasized that losing Medicaid coverage goes beyond mere inconvenience. Many enrolled individuals likely cannot afford their medical costs independently and might not qualify for subsidies under the Affordable Care Act.
This could leave some unable to pay for necessary medications or treatments, which can be devastating for their health, she added.
“Ultimately, this is about people’s lives,” she stated.
