Mass. will spend millions to comply with Trump's health policies

Massachusetts is facing at least $30 million in new costs over the next year to comply with federal health policies enacted in President Trump’s sweeping 2025 budget bill.

The legislation, known as the One Big Beautiful Bill Act, limits who qualifies for public health programs and reduces funding to states. It represents a significant hit for Medicaid programs, which provide coverage for low-income families, people with disabilities and others who qualify.

State officials expect hundreds of thousands of people eventually could lose coverage because of the federal changes.

Officials told WBUR the bulk of the new costs, about $21 million, will go toward upgrading computer systems needed to determine who is eligible for Medicaid — as well as boosting call center staff to respond to an anticipated increase in calls. The call center is staffed by a vendor.

Additionally, the state Medicaid program — MassHealth — will hire more in-house staff to process applications. It will also ramp up outreach to many of its nearly 2 million members, through letters and text messages, said Elizabeth LaMontagne, chief operating officer of MassHealth.

“We have to make sure we have the infrastructure to support these changes,” LaMontagne said. “We'll be seeing increased workload, increased volume, increased calls.”

The $30 million in new administrative costs are included in Gov. Maura Healey’s $63 billion budget proposal for the fiscal year that begins July 1.

They represent a fraction of overall state spending, and a small slice of the more than $22  billion allocated for MassHealth, but come at a time when health care costs are already straining budgets.

And more pressures are looming: the federal budget law will reduce funding coming into the state for MassHealth by an estimated $3.5 billion annually once fully implemented. Nationally, the law is expected to reduce federal Medicaid spending by $911 billion over a decade.

“We're seeing a really sharp increase in the cost of providing health care,” LaMontagne said. “What's coming out of D.C. is making things worse.”

The federal budget law contains a flurry of health care provisions, but two in particular will reshape MassHealth. One is a new requirement that many adults work at least 80 hours a month, or earn at least $580 a month.

The other is twice-yearly eligibility checks for certain adults. Both of these changes begin in January 2027. Both demand more paperwork from individuals and the state.

The stakes are high. As federal rules change, people who qualify for coverage could fall through the cracks and lose their benefits simply because they fail to meet paperwork deadlines.

In addition, the federal law will require some MassHealth members to contribute co-pays for medical care beginning in 2028. It will also make certain groups of lawfully present immigrants ineligible for public coverage.

State officials expect about 360,000 MassHealth members will be subject to work requirements or more frequent eligibility checks. There are many exemptions. For example, adults who are elderly, disabled, or have young children do not need to be working.

Ashley Blackburn, interim executive director of the consumer advocacy group Health Care For All, said the federal work requirements are onerous and could create barriers for people who need access to care. She said her staff plans to work with state officials to make sure the new policies “harm as few Massachusetts residents as possible.”

Federal data, however, shows most people on Medicaid already work.