FQHC Impact Tracker — Lives, Health & Cost of the 2026 Safety-Net Cuts

Every coverage loss, benefit cut, and cost shift hitting community health — quantified by lives impacted, the individual and population-health consequences, and the dollar cost. Across California, Texas, and every U.S. state, plus federal policy. Every figure primary-sourced.

Last updated: July 27, 2026

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175

Tracked Impacts

States Covered

California

Texas

Federal

Already in Effect

What's at Stake — In Verified Figures

~100,000

lawfully present immigrants lose Medicare (Jan 4 2027)

~2M

lose Medi-Cal dental on July 1

$9.5B/yr

H.R. 1 cost shift onto CA counties

~588,000

Texans stuck in the coverage gap

Every figure is primary-sourced and carries a confidence level (confirmed count, modeled projection, or estimate). Figures come from different sources, timeframes, and populations that may overlap — so they are not summed into one grand total.

175 results

ProjectedCoverage LossFederalModeled projection

Medicaid work requirements put 5.6M community health center patients at risk

5.6M

Lives Impacted

—

Cost Estimate

Lives Impacted

Community health center patients in expansion states subject to the 80-hours/month requirement (CA in scope; TX excepted)

Cost Estimate · Who bears it

Patients (lost coverage) + FQHCs (rising uncompensated care)

Individual Health

A working patient who misses a paperwork deadline loses Medicaid mid-treatment and skips a follow-up.

Population Health

Redetermination churn opens coverage gaps across expansion states; FQHC eligibility teams must scale navigation by Jan 1, 2027.

Timeframe: Implement by Jan 1, 2027 (IFR June 1, 2026)Source: American Hospital Association (CMS-2454-IFC) / Commonwealth Fund

ProjectedCoverage LossFederalModeled projection

KFF: new public-charge policies could push 1.4M–4.1M people off Medicaid and CHIP

1.4M–4.1M projected disenrollments (modeled projection); plus 166,000–498,000 eligible people forgoing enrollment

Lives Impacted

Not quantified in dollars by the source

Cost Estimate

Lives Impacted

Medicaid and CHIP enrollees living in households with a noncitizen — about 13.5 million people. KFF derives the range by applying a 10%–30% disenrollment rate to that population; it is explicitly a model, not an observed count, and KFF published no state-level breakdowns. The chilling effect is the mechanism: eligible people, including U.S.-citizen children, disenroll or decline to enroll out of fear that using coverage will count against an immigration determination.

Cost Estimate · Who bears it

Health centers and safety-net providers absorbing uncompensated care as patients lose coverage but keep needing care.

Individual Health

A parent drops coverage for a citizen child to avoid an immigration risk, and the child's asthma controller or well-child visits stop. The clinical damage shows up months later as an avoidable ED visit, not on the day of disenrollment.

Population Health

This is the single most FQHC-shaped number in the current national picture: health centers serve a disproportionate share of mixed-status households, so a chilling effect of this magnitude converts directly into uninsured visits and uncompensated care rather than into patients disappearing. Expect the volume to stay and the revenue to leave.

Timeframe: KFF analysis published July 20, 2026; chilling effects typically begin before formal implementationSource: KFF

ProjectedCoverage LossOhioModeled projection

Ohio Medicaid projected to lose $33B over a decade under H.R. 1

>3M

Lives Impacted

$33B (10-yr projected)

Cost Estimate

Lives Impacted

Ohio’s 3 million-plus Medicaid enrollees, with home- and community-based services most exposed

Cost Estimate · Who bears it

Ohio Medicaid / providers

Individual Health

Cuts to home- and community-based services can push a disabled enrollee toward costlier institutional care or lost supports.

Population Health

A projected $33B decade-long funding loss against a $43.2B FY2025 program — FQHCs face rising uninsured volume as coverage and reimbursement contract.

Timeframe: Over the next decadeSource: Springfield News-Sun / Journal-News

In EffectRate CutNorth CarolinaConfirmed count

$319M NC Medicaid Rebase Shortfall Forced Provider Rate Cuts Threatening 3 Million+ Residents

3M+

Lives Impacted

$319M shortfall

Cost Estimate

Lives Impacted

North Carolina Medicaid enrollees whose care access was threatened by FQHC and provider rate cuts in October 2025

Cost Estimate · Who bears it

North Carolina FQHC providers (rate cuts) and Medicaid enrollees (access risk)

Individual Health

An FQHC in rural Bertie County that depends on Medicaid for the majority of its revenue saw reimbursement drop 3-10% in October 2025, threatening staffing levels at the only primary care practice within 30 miles for hundreds of uninsured and low-income patients.

Population Health

A $319M Medicaid rebase funding gap triggered 3% across-the-board and 8-10% selective provider rate cuts effective Oct. 1, 2025, directly hitting FQHC reimbursement. Governor Stein reversed them Dec. 10, 2025, warning Medicaid could exhaust funds before fiscal year end — threatening care for 3M+ residents.

Timeframe: Rate cuts Oct. 1 – Dec. 10, 2025; rates restored but underlying shortfall unresolvedSource: NC Governor's Office / NCDHHS

In EffectRate CutNew YorkConfirmed count

NY Medicaid pays FQHCs only 70% of cost using 1999-era rates; $80M budget win falls $220M short of the fix

~2.5 million

Lives Impacted

$80M increase (vs. $300M needed)

Cost Estimate

Lives Impacted

New Yorkers served at 70+ FQHC organizations at nearly 900 sites, concentrated in NYC, whose health centers operate at a 30% per-visit Medicaid underpayment relative to actual cost

Cost Estimate · Who bears it

NY FQHCs absorb the $220M structural shortfall through cross-subsidy from grants and reserves; patients absorb reduced services if centers cannot close the gap

Individual Health

A health center CEO in the Bronx must subsidize every Medicaid patient visit out of federal grants and reserves because the state still uses 1999-2000 cost data to set rates, spending about 40% more per visit than Medicaid reimburses.

Population Health

Urban Institute analysis: NY Medicaid reimburses health centers ~70% of care cost (centers spend ~40% more per visit than paid); Medicaid is ~42% of CHC revenue. CHCANYS sought $300M for a full fix in FY2027; the enacted budget delivered $80M — leaving the structural gap largely unresolved for 2.5M patients.

Timeframe: FY2027 budget enacted May 2026; structural rate problem persists until A.7560/S.6959 passesSource: CBS6 Albany / WRGB

ProposedCoverage LossFederalModeled projection

CMS proposes codifying Medicaid provider-tax limits — $246B in federal savings and 2.4 million people projected to lose coverage over a decade

~2.4M projected to lose Medicaid over ten years (modeled projection, not a count)

Lives Impacted

$246B federal savings over ten years (CMS actuaries' estimate)

Cost Estimate

Lives Impacted

Medicaid enrollees nationally, concentrated in expansion states that lean hardest on provider taxes to fund the non-federal share. Under the proposed rule, expansion-state provider taxes phase down 0.5 percentage points annually starting in 2028 until they reach 3.5% by 2032, and the current 6% 'hold harmless' threshold is replaced with per-state, per-provider thresholds pegged to each state's taxes as of July 4, 2025. California and Illinois already exceed the proposed 3.5% floor; New York's managed-care tax raises billions annually. This is a PROPOSED rule — nothing has taken effect, and the projection comes from CMS actuaries, not from observed disenrollment.

Cost Estimate · Who bears it

State Medicaid programs, which must replace the lost non-federal share from general funds or reduce spending; ultimately enrollees and safety-net providers.

Individual Health

For an individual enrollee the mechanism is indirect but real: provider taxes fund the state share of Medicaid, so capping them forces states to cut rates, narrow eligibility, or backfill from general funds. Enrollees feel it as reduced provider participation and longer waits before they feel it as lost coverage.

Population Health

Health centers sit downstream of state Medicaid financing rather than of provider taxes directly — no FQHC pays a provider tax as such. The exposure is that a state facing a shrinking non-federal share has historically reached for rate actions and eligibility tightening, both of which land on the safety net. California's exposure is above average because its current tax level already exceeds the proposed floor.

Timeframe: Proposed rule published July 2026; phase-down would begin 2028 and reach the 3.5% floor by 2032Source: Healthcare Dive

In EffectCoverage LossFederalConfirmed count

2.13 million fewer children are enrolled in Medicaid/CHIP than in January 2025 — an observed count, with causation the researchers themselves say they cannot fully explain

2.13M fewer children enrolled in Medicaid/CHIP since January 2025 (observed count from CCF's enrollment tracker)

Lives Impacted

Not quantified — CCF reports the enrollment decline, not a dollar figure

Cost Estimate

Lives Impacted

Children nationally. Georgetown University's Center for Children and Families reported on July 24, 2026 that 'our Medicaid/CHIP enrollment tracker shows that, as of today, there are 2.13 million fewer children enrolled in Medicaid/CHIP since January 2025.' READ THE CAUSATION HONESTLY, BECAUSE CCF DOES: the researchers write, 'We don't know how to account for such a sharp drop in enrollment, but the chilling effect is undoubtedly one of the causes,' and they name several contributing factors — the deportation agenda, Medicaid data sharing with ICE, and general fear within immigrant families — alongside the public charge rule. This figure is an observed enrollment decline, not an attribution to any single policy. It is the counted complement to the separately tracked KFF modeling of public-charge disenrollment (1.4M-4.1M projected), and the two should be cited as different kinds of evidence, never added together.

Cost Estimate · Who bears it

Health centers absorb the cost as uncompensated and sliding-fee pediatric care; families absorb it as deferred care and out-of-pocket spending.

Individual Health

A child who loses Medicaid/CHIP loses well-child visits, immunization schedules, dental care, and asthma and behavioral-health management — the services where continuity matters most and where a gap compounds. Disenrollment driven by fear rather than ineligibility is especially costly, because the child usually still qualifies and the family simply stops coming.

Population Health

Health centers are where this shows up first and most visibly, because pediatric panels at FQHCs skew heavily Medicaid/CHIP. A child who disenrolls does not stop needing care; the visit moves onto the sliding-fee schedule or disappears until it becomes an emergency. Watch your own no-show and sliding-fee mix rather than waiting for national data — that is the earliest local signal of a chilling effect, and it moves before any policy takes formal effect. The public charge rule itself does not take effect until September 18, 2026.

Timeframe: Enrollment decline measured January 2025 through July 2026; public charge rule effective September 18, 2026Source: Georgetown University Center for Children and Families

ProjectedBenefit CutCaliforniaEstimate

~2M immigrant adults lose full-scope Medi-Cal dental

~2M

Lives Impacted

$308M

Cost Estimate

Lives Impacted

Immigrant adults ages 19-54 with Unsatisfactory Immigration Status — emergency-only dental thereafter

Cost Estimate · Who bears it

$308M FY26-27 state 'savings' = patients' out-of-pocket cost and forgone care

Individual Health

Untreated decay becomes an abscess; the patient ends up in the ER for pain and loses the tooth.

Population Health

FQHC dental panels shrink and ED dental visits rise — a double hit with the UIS-PPS cut on the same patients (both deferred to July 1, 2027 in the signed 2026-27 budget).

Timeframe: Deferred to July 1, 2027 — 2026-27 budget signed June 29, 2026Source: National Health Law Program / Justice in Aging

In EffectRate CutFloridaConfirmed count

FQHC Medicaid PPS Rate Unchanged for 20+ Years Leaves $106 (42.2%) Gap Per Visit in Florida

~1.72M

Lives Impacted

$106/visit gap

Cost Estimate

Lives Impacted

patients served by Florida's ~54 FQHC organizations whose care is underfunded by $106/visit on Medicaid

Cost Estimate · Who bears it

Florida FQHCs absorbing the unreimbursed cost of every Medicaid visit

Individual Health

A Medicaid patient visiting a Jacksonville FQHC for a prenatal check-up generates $106 less in reimbursement than the actual cost of care — a structural gap the health center absorbs on every one of its roughly 1.72 million annual patient visits.

Population Health

FACHC reports current Medicaid PPS rates leave a $106/visit reimbursement gap — about 42.2% below actual cost — across all ~54 FL FQHC organizations serving ~1.72 million patients; FACHC has not requested a rate increase in over 20 years.

Timeframe: Ongoing; FACHC brought rate-increase request to 2026 legislative sessionSource: Florida Association of Community Health Centers (FACHC)

ProjectedCost ShiftCaliforniaNorth StateModeled projection

Rural counties warn H.R. 1 shifts $9.5B/yr onto California and could drop 1.5M from Medi-Cal

~1.5M

Lives Impacted

$9.5B/yr

Cost Estimate

Lives Impacted

Californians who could lose Medi-Cal; rural counties (e.g., Tehama, served by Ampla Health) hit hardest

Cost Estimate · Who bears it

California state + county governments (cost shift)

Individual Health

A rural patient loses the only clinic within driving distance when the county cuts indigent-care wrap-around.

Population Health

Counties absorb new indigent-care obligations without dedicated funding; thin rural safety nets are disproportionately exposed.

Timeframe: FY26-27 → FY27-28Source: Tehama County Board of Supervisors / Action News Now

ProjectedCoverage LossFloridaModeled projection

~1.5 Million Floridians Projected to Lose Coverage as ACA Credits Expire; $5.2B Uncompensated Care

~1.5M

Lives Impacted

$5.2B uncompensated care

Cost Estimate

Lives Impacted

Floridians projected to lose health insurance as enhanced ACA premium tax credits expire, mostly low-income non-expansion adults

Cost Estimate · Who bears it

Florida FQHCs and hospitals absorbing uncompensated care from newly uninsured patients

Individual Health

A 42-year-old restaurant worker in Miami-Dade who paid $60/month for marketplace coverage with enhanced subsidies will see her premium more than double without the credits, leaving the FQHC sliding-fee scale as her only option for the diabetes management she needs every quarter.

Population Health

Florida Policy Institute projects ~1.5M Floridians (range 1.1-1.9M) will lose health insurance — ~1.4M from ACA marketplace changes alone — pushing the uninsured rate from a record-low 10.7% (2023) toward ~16.7%; resulting uncompensated care estimated at $5.2B, highest in the nation.

Timeframe: Enhanced credits expired end of 2025; coverage losses materializing through 2026Source: Florida Policy Institute

In EffectAccess GapLouisianaConfirmed count

Louisiana begins rural transformation with more than $208M and five-year potential above $1B

nearly 1.1M rural residents

Lives Impacted

>$208M current award

Cost Estimate

Lives Impacted

People living in Louisiana's rural parishes, the population identified by LDH for workforce, technology, delivery-model, and coordination investments

Cost Estimate · Who bears it

Federal CMS/HHS funding administered through the Louisiana Department of Health

Individual Health

A rural patient who currently travels for specialty or behavioral health care could benefit if awarded projects add local capacity, telehealth infrastructure, or coordinated referral pathways.

Population Health

LDH says nearly 1.1 million Louisianans live in rural parishes. The April 7 office announcement describes more than $208 million in current federal funding and potential to draw down more than $1 billion over five years; later-year totals are not guaranteed.

Timeframe: Office established April 7, 2026; current Budget Year 1 opportunities run into August 2026 and Year 1 spending can extend through September 2027Source: Louisiana Department of Health

In EffectCoverage LossTexasModeled projection

ACA premium credits expired — ~1M Texans projected to lose coverage by 2034

~1M

Lives Impacted

+$700/yr premiums

Cost Estimate

Lives Impacted

Texans projected to lose marketplace coverage by 2034 (of ~4M enrolled, 95% subsidized)

Cost Estimate · Who bears it

Texas marketplace enrollees (higher premiums)

Individual Health

A self-employed Texan's premium jumps more than $700, so they drop coverage and skip preventive care.

Population Health

In a non-expansion state, marketplace coverage is the main insured path — its erosion drives uncompensated-care pressure onto FQHCs.

Timeframe: Expired Dec 31, 2025Source: Texas Hospital Association

In EffectAccess GapOhioConfirmed count

Medicaid covers ~52% of Ohio's ~1M FQHC patients — largest payer at risk from concurrent federal cuts

~1 million

Lives Impacted

—

Cost Estimate

Lives Impacted

Patients served across Ohio's ~59-60 FQHCs at roughly 550 sites in 76 of 88 counties; about 52% insured by Medicaid, making Ohio health centers serve 1 in 7 Ohio Medicaid beneficiaries

Cost Estimate · Who bears it

Ohio FQHCs (majority of revenue from Medicaid and Section 330 federal grants, both at risk); 1 million patients bear access consequences

Individual Health

A rural Appalachian farmworker in Meigs County — one of Ohio's persistent-poverty counties — who relies on a community health center as the only primary-care option within 30 miles faces a double threat: potential Medicaid loss from work requirements and a Section 330 grant cliff at year-end that could force the center to cut services.

Population Health

GW Geiger Gibson factsheet (Jan 2025): Ohio CHCs serve nearly 1M patients statewide across 550+ sites; Medicaid covers ~52% of patients and is the largest revenue source. The combination of H.R.1 work requirements, a $5.13B year-one Medicaid spending cut, and the December 31, 2026 Community Health Center Fund cliff threatens both coverage and FQHC financial viability simultaneously.

Timeframe: Ongoing; compounded by January 2027 work-requirement deadline and December 31, 2026 CHCF cliffSource: GW Geiger Gibson Program in Community Health

ProposedAccess GapPennsylvaniaConfirmed count

PA Safety Net Serves 1M+ Patients With No Dedicated State Budget Line — PACHC Requests $5M

1M+

Lives Impacted

$5M requested

Cost Estimate

Lives Impacted

Patients served annually across Pennsylvania's 450+ FQHC sites, 44% on Medicaid/CHIP, 16% uninsured

Cost Estimate · Who bears it

Pennsylvania state general fund (FY2026-27 budget ask)

Individual Health

A farmworker in Lancaster County with no insurance relies on her FQHC as her only source of primary care; without the modest state investment PACHC is requesting, her center faces hiring freezes that lengthen wait times from days to weeks.

Population Health

Pennsylvania's ~51 FQHC organizations operate 450+ sites serving over 1 million patients per year. PACHC requested just $5 million for FY2026-27 — down from a prior $50M ask — in a state that is one of only four without a dedicated FQHC budget line.

Timeframe: FY2026-27 state budget cycle, alongside Dec. 31, 2026 federal CHCF cliffSource: WESA (90.5, Pittsburgh NPR)

In EffectCost ShiftIndianaConfirmed count

Indiana FQHCs received nearly $88M in 2024 primary-care grants; the January 2025 access interruption was resolved

~700,000 served

Lives Impacted

Nearly $88M awarded in 2024

Cost Estimate

Lives Impacted

Estimated people served by Indiana FQHCs; this is a service-population count, not a count of people who lost care

Cost Estimate · Who bears it

Federal government through HRSA primary-care grants; the article does not quantify a lasting shortfall

Individual Health

The article says HealthNet served about 61,000 patients and federal grants represented about 24% of HealthNet's budget. It does not document a closure, staffing cut or individual loss of care.

Population Health

WFYI reported nearly $88 million in 2024 HRSA primary-care grants across Indiana FQHCs. IPHCA said as many as one-third of its more than 40 members could not access grants during the two weeks after a January 2025 freeze; the issue was resolved and all members were receiving funds by publication. The 24% figure applies to HealthNet alone.

Timeframe: 2024 grant total; temporary access disruption reported after January 2025 freeze and resolved by February 26, 2025Source: WFYI Indianapolis

In EffectAccess GapNorth CarolinaConfirmed count

NC Medicaid Expansion Tops 687,000 Enrollees, Sharply Improving FQHC Payer Mix

687,000+

Lives Impacted

—

Cost Estimate

Lives Impacted

North Carolinians newly covered by Medicaid expansion since December 2023

Cost Estimate · Who bears it

Federal government (90% FMAP for expansion population)

Individual Health

At Western NC Community Health Services, a patient previously counted as uninsured became a billable Medicaid visit after December 2023 expansion — part of the payer-mix shift that cut the FQHC's uninsured share from 68% to 37% in three years.

Population Health

More than 687,000 North Carolinians enrolled through Medicaid expansion by Nov. 2025 (~690,000 at two years). At one FQHC, uninsured visits fell from 68% (2022) to 37% (2025) while Medicaid visits rose from 13% to ~31%.

Timeframe: Expansion launched December 1, 2023; two-year enrollment figure as of December 2025Source: NC Governor's Office / NC Medical Journal

ProjectedCoverage LossNorth CarolinaModeled projection

H.R. 1 Work Requirements Could Activate NC Auto-Repeal Clause, Ending Coverage for 671,000+ Expansion Enrollees

671,000+

Lives Impacted

—

Cost Estimate

Lives Impacted

North Carolina Medicaid expansion enrollees whose coverage could end if the state auto-repeal clause activates

Cost Estimate · Who bears it

671,000+ enrolled patients and 43 FQHC organizations relying on improved payer mix

Individual Health

A 52-year-old home health aide in rural Robeson County enrolled through Medicaid expansion would lose her only health coverage if NC's auto-repeal clause fires — not because the 90% FMAP dropped, but because H.R.1 work-requirement administrative costs strain state matching capacity.

Population Health

NC expansion topped 687,000 enrollees by Nov. 2025 (~690,000 at two-year mark); H.R.1 work requirements affect ~732,000 NC expansion adults from Jan. 2027. County social services are ~10% understaffed as recertification work is set to double. NC law auto-repeals expansion if the state cannot fund its share.

Timeframe: Work-requirement reporting begins January 2027; auto-repeal risk ongoingSource: Smith Anderson / NC Health News

ProjectedCoverage LossWashingtonModeled projection

H.R.1 work requirements risk coverage loss for ~620,000 Washington Apple Health adults starting December 2026

~620,000

Lives Impacted

—

Cost Estimate

Lives Impacted

Non-pregnant Apple Health adults ages 19-64 subject to H.R.1 Medicaid work requirements

Cost Estimate · Who bears it

—

Individual Health

A gig-economy rideshare driver in the Seattle suburbs who is enrolled in Apple Health may lose coverage not because they fail to work 80 hours a month, but because Washington's eligibility-automation system will not be ready to verify compliance until June 2027 — creating a paperwork-driven coverage gap.

Population Health

HCA's Medicaid director warns ~620,000 Washington adults risk losing Apple Health coverage under H.R.1 work requirements starting December 2026, primarily from administrative burden; Washington's eligibility system won't be ready until June 2027, so the state is seeking a delay to December 2028.

Timeframe: Work requirements effective December 2026; state seeking delay to December 2028Source: Washington State Health Care Authority

In EffectCoverage LossTexasConfirmed count

~588,000 Texans are stuck in the Medicaid coverage gap — 42% of the U.S. total

~588,000

Lives Impacted

—

Cost Estimate

Lives Impacted

Uninsured Texas adults who earn too much for Texas Medicaid but too little for marketplace subsidies

Cost Estimate · Who bears it

Patients (no coverage) + FQHCs (sliding-fee + Section 330 reliance)

Individual Health

An adult with no coverage option uses the FQHC sliding fee for everything and avoids the specialist they need.

Population Health

Texas's non-expansion decision is the single largest driver of its nation-leading uninsured rate.

Timeframe: OngoingSource: KFF

ProjectedCoverage LossIllinoisModeled projection

H.R.1 threatens ~500,000 Illinois Medicaid enrollees and $26–51B in lost federal funds over a decade

~500,000

Lives Impacted

$26–51B/decade

Cost Estimate

Lives Impacted

Illinois Medicaid customers projected to lose coverage under H.R.1 work requirements and bi-annual eligibility checks, on top of ~33,000 already lost via HBIA closure

Cost Estimate · Who bears it

Illinois state budget and FQHCs bear rising uncompensated care; federal government withdraws $26–51B over 10 years

Individual Health

An expansion-enrolled adult in Springfield who works part-time and already lost HBIA coverage now faces bi-annual eligibility redeterminations instead of annual ones — any documentation gap triggers disenrollment and an uninsured visit to the FQHC.

Population Health

Illinois HFS projects H.R.1 could cause coverage loss for ~500,000 Medicaid customers and cut between ~$26B and ~$51B in federal funds over a decade; most expansion adults must document 80 hours/month beginning no later than Dec. 31, 2026.

Timeframe: Work requirements begin no later than December 31, 2026; bi-annual checks already enactedSource: Illinois HFS (Healthcare & Family Services)

ProjectedCoverage LossNew YorkModeled projection

H.R.1 Medicaid work requirements hit NY Jan 1, 2027 — up to $13.5B/yr cut and 500,000+ more uninsured

~500,000 by 2029

Lives Impacted

up to $13.5B/yr by 2032

Cost Estimate

Lives Impacted

Medicaid expansion adults ages 19-64 subject to 80-hour/month work requirements; NYSBA projects 500,000 more uninsured by 2029 and over 1 million annually at full implementation

Cost Estimate · Who bears it

New York State Medicaid program; ~$500M additional state administrative costs; patients who lose coverage bear out-of-pocket care costs

Individual Health

A middle-aged unemployed man in Buffalo who receives Medicaid while searching for work and cannot always produce paperwork proving 80 qualifying hours per month risks losing coverage and skipping follow-up care for his hypertension at the local community health center.

Population Health

NYSBA estimates H.R.1 will cut up to $13.5B/yr from NY Medicaid by 2032, raise the uninsured count by ~500,000 by 2029 (1M+ at full implementation), and add ~$500M in state administrative costs for work-requirement verification.

Timeframe: Work requirements effective January 1, 2027; full fiscal impact phased through 2032Source: New York State Bar Association

In EffectCoverage LossNew YorkModeled projection

Essential Plan cliff: ~470,000 New Yorkers lose coverage July 1, 2026 as H.R.1 cuts $7.5B from the program

~470,000

Lives Impacted

$7.5B cut from Essential Plan

Cost Estimate

Lives Impacted

Low-income and immigrant Essential Plan enrollees losing coverage when NY lowers the income limit from 250% to 200% FPL July 1, 2026; concentrated in NYC (233,000), Long Island (~70,000), and the Hudson Valley (~47,000)

Cost Estimate · Who bears it

New York State (absorbs the ~$7.5B federal funding cut through program contraction) and patients who shift to uninsured or sliding-scale FQHC care

Individual Health

A Guatemalan home health aide in the Bronx who earns just above 200% of poverty and held Essential Plan coverage through the expanded income limit will lose her insurance on July 1 and likely seek uncompensated care at a community health center where she already gets her primary care.

Population Health

H.R.1 eliminated premium tax credit eligibility for most lawfully present immigrants — cutting ~$7.5B from NY's $14B Essential Plan budget — forcing NY to lower the income ceiling from 250% to 200% FPL July 1, 2026; Fiscal Policy Institute estimates ~470,000 of 1.7M enrollees lose coverage.

Timeframe: Effective July 1, 2026 (income ceiling drops from 250% to 200% FPL)Source: Fiscal Policy Institute

ProjectedCoverage LossNew YorkNew YorkConfirmed count

New York's Essential Plan cliff: ~450,000 lose $0-premium coverage July 1, 2026

~450,000

Lives Impacted

$300M need

Cost Estimate

Lives Impacted

New Yorkers earning 200–250% FPL who lose the expanded Essential Plan and are pushed into premium/deductible marketplace plans

Cost Estimate · Who bears it

NY FQHCs/clinics (uncompensated-care surge); state offers $50M vs. ~$300M requested

Individual Health

A home health aide at 230% FPL goes from $0 premium to a plan with monthly premiums and a deductible — and starts skipping the medications she can no longer afford.

Population Health

Advocates call it the largest, most rapid coverage loss in NY history; FQHCs (serving ~2.4M NY patients) absorb the uninsured surge while the state Senate offers clinics only $50M against a ~$300M need.

Timeframe: Coverage ends July 1, 2026Source: New York State Senate / NY Health Access

ProjectedRate CutHawaiiModeled projection

Hawaiʻi Medicaid Payment Reductions Are Expected to Begin in 2028 Against a 429,000-Enrollee Baseline

~429,000

Lives Impacted

—

Cost Estimate

Lives Impacted

Hawaiʻi residents enrolled in Medicaid as of January 2026; this is the statewide enrollment baseline, not a forecast that 429,000 people will lose coverage or access

Cost Estimate · Who bears it

Provider and patient effects are projected but not monetized in the source

Individual Health

The article says lower reimbursements can make it harder for patients to find participating clinicians, but it does not identify a patient, an FQHC service reduction or an individual coverage loss caused by the future rate change.

Population Health

Civil Beat reports that certain Hawaiʻi Medicaid payments already set 20% above Medicare must decline incrementally beginning in 2028 and reach the Medicare level by 2030. The cited 429,000 is January 2026 enrollment, while the magnitude of provider-rate, access and FQHC effects is not quantified.

Timeframe: Incremental reductions are reported to begin in 2028 and reach the Medicare level by 2030Source: Honolulu Civil Beat

In EffectRate CutOregonConfirmed count

OHA cuts ~$170M in quality-incentive payments to primary care to fund H.R.1 implementation mandates

~429,000

Lives Impacted

~$170M this fiscal year

Cost Estimate

Lives Impacted

Patients at Oregon community health centers, which serve 22% of Oregon Health Plan (Medicaid) beneficiaries; quality-incentive payment cuts flow directly to primary care clinics, family doctors, pediatricians, and OB-GYNs serving low-income Oregonians

Cost Estimate · Who bears it

Oregon primary care clinics and community health centers (lose quality-incentive revenue they planned operational budgets around)

Individual Health

A pediatric patient at a Willamette Valley community health center whose clinic loses a portion of its annual quality-incentive payment — income the center counted on to keep staffing levels stable — may find appointment availability tightening as the clinic absorbs a cut it did not budget for.

Population Health

OHA asked legislators (January 2026) to authorize 27 new state positions while slashing $200M+ in OHP quality-incentive funds; ~85% (~$170M) flows directly to primary care clinics serving low-income Oregonians. Oregon CHCs serve 22% of all Oregon Health Plan members and are directly exposed to these payment reductions.

Timeframe: January 2026 OHA request to legislature; cuts flow through the current fiscal yearSource: OPB

ProjectedCoverage LossMassachusettsModeled projection

Massachusetts: up to 410,000 MassHealth members flagged at risk under federal work requirements — 110,000 more than first estimated

up to ~410,000

Lives Impacted

—

Cost Estimate

Lives Impacted

MassHealth members — including parents, children, elderly adults, and people with disabilities on cash-assistance programs — who will need new paperwork to keep coverage starting in 2027. State officials recently found up to 110,000 more people at risk than the ~300,000 first flagged.

Cost Estimate · Who bears it

Patients (coverage loss) and Massachusetts FQHCs (uncompensated care)

Individual Health

A disabled MassHealth member who cannot navigate new documentation loses coverage and delays care until a crisis brings them to an FQHC or the ER.

Population Health

The expanded at-risk population raises the uninsured and under-insured load on Massachusetts community health centers ahead of 2027 enforcement.

Timeframe: Redeterminations/paperwork begin in 2027Source: The Boston Globe

In EffectCoverage LossIndianaConfirmed count

WFYI reports roughly 400,000 fewer Medicaid enrollees since early 2025; work requirements had not started

~400,000

Lives Impacted

Nearly $400M in state-attributed savings

Cost Estimate

Lives Impacted

Reported reduction in total Indiana Medicaid enrollment since early 2025; the source attributes it in part to income checks, not to work requirements that had not started

Cost Estimate · Who bears it

State officials attributed nearly $400M in savings to enrollment decline and eligibility checks; the article does not quantify costs shifted to FQHCs

Individual Health

The article explains that under the federal medical-frailty rule, a serious diagnosis such as HIV or cancer alone may not create a blanket exemption; the person must show that the condition prevents the required work. It does not document an individual loss of coverage.

Population Health

WFYI reports roughly 400,000 fewer Medicaid enrollees since early 2025. Hoosier Action attributed the decline to more frequent income checks; the source does not say work requirements caused it. Hospital data showed a separate nearly 17% increase in emergency-department visits from January through August 2025, with many patients uninsured, but does not establish that enrollment loss caused the full increase.

Timeframe: Enrollment comparison since early 2025; separate emergency-department change measured January–August 2025Source: WFYI Indianapolis

ProjectedCost ShiftColoradoEstimate

About 378,500 Colorado Medicaid members may face work requirements before exemptions; FY2026-27 implementation is estimated at $45.8M

~378,500 before exemptions

Lives Impacted

$45.8M total funds (FY2026-27)

Cost Estimate

Lives Impacted

Estimated low-income adults ages 19–64 potentially subject to the requirement before exemptions, based on current enrollment

Cost Estimate · Who bears it

$5.6M Colorado General Fund within $45.8M total funds; remaining shares are not specified in this summary

Individual Health

A relevant new applicant must document the preceding month; an existing member must meet the threshold in at least one calendar month within the six-month renewal period unless an exemption or compliance can be verified.

Population Health

HCPF estimates $5.4 million in total funds in FY2025-26 and $45.8 million in FY2026-27 for initial Medicaid eligibility implementation. It says affected-member letters begin in August 2026 and cautions that both cost and population estimates may change.

Timeframe: $5.4M total funds in FY2025-26; $45.8M in FY2026-27; relevant applications and renewals begin January 2027Source: Colorado Department of Health Care Policy & Financing (HCPF)

ProjectedCost ShiftMissouriModeled projection

Missouri's $532.2M Medicaid Expansion Reserve Was Projected to Run Out as Soon as Late 2026

~358,000

Lives Impacted

$532.2M reserve balance at Sept. 30, 2025

Cost Estimate

Lives Impacted

Low-income adults enrolled through Missouri's voter-approved Medicaid expansion as reported in November 2025

Cost Estimate · Who bears it

Missouri general revenue if temporary expansion reserves are not replaced by a recurring state appropriation

Individual Health

An adult enrolled through expansion does not lose eligibility solely because temporary reserve accounts are exhausted; the cited analysis instead warns of payment delays and service disruption if lawmakers do not move the state match into a recurring appropriation.

Population Health

Missouri used about $968 million of temporary American Rescue Plan incentive funding to bridge the state share of expansion. The two reserve accounts held $532.2 million on September 30, 2025, after draws of $212 million in 2024 and $359.6 million in the first nine months of 2025. At the reported draw rate of about $40 million per month, exhaustion was projected as soon as late 2026.

Timeframe: Projected reserve exhaustion as soon as late 2026 at the reported draw rateSource: Missouri Independent

ProposedCost ShiftMissouriEstimate

Missouri Proposed $45.5M for Medicaid Work-Requirement Staffing and Systems Within a $294.6M Safety-Net Request

346,753

Lives Impacted

$45.5M proposed for staffing and systems; $294.6M broader request

Cost Estimate

Lives Impacted

Missouri adult-expansion enrollees reported on February 20, 2026, before the January 2027 federal work-requirement start

Cost Estimate · Who bears it

Missouri and federal taxpayers financing work-requirement staffing and eligibility-system changes

Individual Health

An expansion enrollee may have to document work, school or community service for 80 hours a month and complete eligibility review twice a year beginning January 1, 2027; the state was still awaiting some federal verification guidance at publication.

Population Health

The governor's FY2027 plan proposed $12.5 million in state and federal funds for additional implementation staff time and $33 million for system upgrades. Those Medicaid-specific amounts sat within a broader $294.6 million Department of Social Services request, including $35 million in general revenue, for federally mandated changes across safety-net programs.

Timeframe: Proposed FY2027 implementation spending; federal requirements begin January 1, 2027Source: Missouri Independent

ProjectedCoverage LossOhioModeled projection

H.R.1 work requirements projected to strip 337,000+ Ohioans of Medicaid and cut $5.13B in year one

~337,000

Lives Impacted

$5.13B year-one Medicaid cut

Cost Estimate

Lives Impacted

Ohio Medicaid expansion adults ages 19-64 who lose coverage when 80-hour/month community-engagement requirements take effect no later than January 1, 2027; Urban Institute estimates the range at 261,000-412,000

Cost Estimate · Who bears it

Ohio Medicaid program ($5.13B year-one decline); Ohio FQHCs lose half-patient Medicaid revenue stream; patients bear cost of uninsured care or forgo it

Individual Health

A 35-year-old warehouse temp worker in Columbus who moves between short-term contracts and has stretches without paycheck documentation could lose the Medicaid coverage that keeps her diabetes managed at her community health center.

Population Health

Center for Community Solutions modeling: ~337,000 Ohioans (10.7% enrollment drop, range 261,000-412,000) lose Medicaid in year one under H.R.1; first-year Medicaid spending declines $5.13B ($53.3B over a decade). Medicaid covers ~half of Ohio's ~1M FQHC patients.

Timeframe: State 1115 waiver eligibility review begins January 2026; federal H.R.1 work requirements enforceable no later than January 1, 2027Source: The Center for Community Solutions

In EffectCoverage LossMissouriConfirmed count

Missouri Recorded 333,265 Medicaid Terminations in 14 Months, 91.9% for Procedural Reasons

333,265 terminations

Lives Impacted

—

Cost Estimate

Lives Impacted

MO HealthNet coverage-termination cases recorded between January 2025 and February 2026; the source does not establish a deduplicated count of unique people

Cost Estimate · Who bears it

The report does not quantify a statewide dollar cost or allocate costs among members, assisters, providers or agencies; it documents administrative workload to process renewal paperwork and attach submissions to case files

Individual Health

When MO HealthNet needs more information, it sends a non-renewal form that must be returned within 30 days. The cited report documents cases that can auto-close while material submitted near the deadline is still waiting to be manually attached to the member's file.

Population Health

CMS data cited by KCUR show 333,265 coverage terminations from January 2025 through February 2026, with 91.9% classified as procedural because the state could not determine continued eligibility from the available forms or information. Missouri completed 56.5% of renewals ex parte in the final quarter of 2025.

Timeframe: Observed January 2025 through February 2026, before federal work requirements and twice-yearly reviews beginSource: KCUR

ProjectedCoverage LossNew JerseyModeled projection

NJ models 165,000-330,000 NJ FamilyCare losses and up to $3.7B in annual fiscal impact

165,000-330,000 by SFY2029/2030

Lives Impacted

$1.8B-$3.7B/yr by SFY2030

Cost Estimate

Lives Impacted

NJ FamilyCare participants, principally among approximately 540,000 ACA expansion members subject to new work requirements

Cost Estimate · Who bears it

New Jersey's health-care system and public budgets through lost federal investment, higher state costs, and provider-funding reductions

Individual Health

An eligible NJ FamilyCare expansion member whose wages or exemption cannot be verified automatically may have to answer a document request at renewal; a missed notice can turn an administrative gap into delayed primary care and prescriptions.

Population Health

NJ Human Services models 10,000-30,000 enrollment losses in SFY2027, 130,000-265,000 in SFY2028, and 165,000-330,000 in both SFY2029 and SFY2030. The agency explicitly labels these as projections that depend on federal guidance, enrollment, and implementation performance.

Timeframe: The cited projection begins its modeled effects in SFY2027 and reaches the displayed range in SFY2029-SFY2030; a separate state member-guidance claim tracks current operational dates without importing them into this projection recordSource: New Jersey Department of Human Services

ProjectedCoverage LossPennsylvaniaModeled projection

Pennsylvania: state projects 310,000 residents will lose Medicaid under the new federal work-requirement rule

~310,000

Lives Impacted

—

Cost Estimate

Lives Impacted

Pennsylvania Medicaid enrollees subject to the 80-hour/month community-engagement requirement taking effect January 1, 2027. Pennsylvania has joined a 25-state-plus-DC lawsuit challenging CMS's interim final rule for narrowing the statutory 'medically frail' exemption.

Cost Estimate · Who bears it

Patients (coverage loss) and Pennsylvania FQHCs (uncompensated care)

Individual Health

A Pennsylvanian with a chronic condition who misses a paperwork deadline loses Medicaid and returns to an FQHC uninsured, on the sliding-fee scale.

Population Health

The projected loss expands the uninsured pool Pennsylvania's community health centers are legally required to serve, concentrated among low-income adults, ahead of January 1, 2027 enforcement.

Timeframe: Projected when work requirements take effect January 1, 2027Source: The Philadelphia Inquirer

In EffectCoverage LossAlabamaEstimate

~300,000 Alabamians remain uninsured in the Medicaid coverage gap; state forgoes $619M/yr in federal funds

~300,000

Lives Impacted

$619M/yr

Cost Estimate

Lives Impacted

Adults earning too much for traditional Medicaid but too little for marketplace subsidies — the coverage gap created by Alabama's refusal to expand

Cost Estimate · Who bears it

Federal government (forgone funds); FQHCs absorb uncompensated care demand

Individual Health

A 38-year-old home-health aide in rural Sumter County earns $14,000 a year — above Alabama's Medicaid cutoff of 18% FPL for parents, below the marketplace subsidy floor — and has no affordable coverage option.

Population Health

Alabama covers parents only at ~18% FPL and excludes childless adults entirely, leaving roughly 300,000 residents in the coverage gap while forgoing an estimated $619 million annually in federal matching funds.

Timeframe: Ongoing; no expansion vote scheduled as of March 2026Source: Fox 10 News (WALA)

ProjectedCoverage LossArizonaModeled projection

300,000+ Arizonans projected to lose AHCCCS under H.R.1 work requirements and twice-yearly renewals

300,000+

Lives Impacted

$700M+/yr

Cost Estimate

Lives Impacted

AHCCCS expansion adults ages 19-64 at up to 133% FPL who must verify 80 hours/month of work, school, or volunteering starting January 2027

Cost Estimate · Who bears it

Arizona FQHCs (Medicaid revenue at risk); patients lose coverage access

Individual Health

A seasonal farm worker in Yuma County who picks crops eight months a year faces a coverage gap in the off-season unless she can document exempt status through AHCCCS's new twice-yearly renewal portal.

Population Health

Arizona's 24 FQHCs serve ~870,000 patients — 43% on AHCCCS — generating over $700 million a year (~two-thirds of patient revenue); AACHC warns every 1% coverage drop costs a clinic ~$1M/year, and 300,000+ are projected to lose coverage.

Timeframe: Work requirements begin January 2027; twice-yearly renewals also January 2027Source: Arizona Center for Investigative Reporting (AZCIR)

ProposedRate CutWashingtonEstimate

Gov. Ferguson's pharmacy carve-out would strip 340B savings from WA health centers — $100M+ annual loss

~298,000

Lives Impacted

$100M+/yr

Cost Estimate

Lives Impacted

Patients served by Sea Mar Community Health Centers alone across 18 Western Washington counties (plus all other WA CHC patients served by 340B-funded programs)

Cost Estimate · Who bears it

Washington community health centers losing 340B drug pricing savings

Individual Health

A Sea Mar patient in a rural Clark County community who receives low-cost medications through the 340B program could face drug costs their family cannot afford if the pharmacy carve-out eliminates the center's ability to generate 340B savings used to cross-subsidize care.

Population Health

Washington community health centers would lose $100M+ annually while the state saves only ~$7.5M; Sea Mar serves ~298,000 patients across 18 counties and warns of service cuts and layoffs.

Timeframe: Proposed in 2025-27 budget; pending legislative decisionSource: The Columbian / Washington Association for Community Health

ProjectedCoverage LossMassachusettsModeled projection

H.R. 1 Threatens Coverage for 250,000+ Massachusetts Residents

250,000+

Lives Impacted

~$1.75B/yr

Cost Estimate

Lives Impacted

MassHealth and Health Connector enrollees projected to lose coverage under H.R. 1 federal Medicaid cuts

Cost Estimate · Who bears it

Massachusetts state budget (MassHealth and Health Connector programs) absorbing lost federal matching funds

Individual Health

A 42-year-old home health aide in Worcester who earns just above the Medicaid threshold will face a documentation deadline she cannot meet while working two jobs — and will lose the MassHealth coverage she relies on for her diabetes management.

Population Health

Massachusetts officials estimate H.R. 1 will cut roughly $1.75 billion in federal MassHealth and Connector funding and cause 250,000+ residents to lose coverage; work/community-engagement requirements for adults 19-64 begin January 1, 2027.

Timeframe: First immigrant-member changes Fall 2026; work requirements begin January 1, 2027Source: Massachusetts Executive Office of Health and Human Services (Mass.gov)

ProjectedCoverage LossWashingtonModeled projection

WACH projects 250,000+ Washingtonians will lose Medicaid under H.R.1

250,000+

Lives Impacted

—

Cost Estimate

Lives Impacted

Washington Medicaid enrollees projected to lose coverage under H.R.1 cuts and work requirements

Cost Estimate · Who bears it

—

Individual Health

A low-income agricultural worker in Eastern Washington who depends on Medicaid for diabetes management at a community health center faces losing coverage if H.R.1 coverage losses materialize, with no local safety-net alternative in rural areas where Apple Health was the only payer.

Population Health

The Washington Association for Community Health projects 250,000+ Washingtonians will lose Medicaid under H.R.1 and warns the law will strain community health centers; it also eliminates federal AHEC workforce development funding.

Timeframe: H.R.1 enacted July 2025; coverage changes phase in through 2027Source: Washington Association for Community Health

ProjectedCoverage LossTexasSouth TexasEstimate

San Antonio: ACA subsidy loss could hit 234,000 Bexar County residents

234,000

Lives Impacted

$75M

Cost Estimate

Lives Impacted

Bexar County residents whose ACA tax credits are at risk as enhanced subsidies lapse

Cost Estimate · Who bears it

University Health (San Antonio) safety-net system

Individual Health

A San Antonio family loses subsidies, becomes uninsured, and turns to an already-stretched safety net.

Population Health

University Health's ED visits are up 77% since 2014; the CFO warns of up to $75M in lost payments as insured patients become uninsured.

Timeframe: FY2026Source: San Antonio Report / University Health

ProjectedCoverage LossCaliforniaSan DiegoModeled projection

San Diego County: ~210,000 residents could lose Medi-Cal under proposed cuts

~210,000

Lives Impacted

>$300M admin

Cost Estimate

Lives Impacted

San Diego County Medi-Cal enrollees exposed to proposed state coverage changes; a broader ~400,000 are at risk of losing Medi-Cal and/or SNAP under the new work requirement

Cost Estimate · Who bears it

San Diego County (work-requirement administrative cost alone estimated above $300M); FQHCs absorb uncompensated-care volume

Individual Health

A South Bay parent who loses Medi-Cal stops filling prescriptions and skips a child's well visit, shifting from a sliding-fee FQHC visit to a delayed ED trip.

Population Health

San Diego's largest FQHCs — Family Health Centers of San Diego, San Ysidro Health, Neighborhood Healthcare, TrueCare, La Maestra — absorb the uninsured surge while modeling the signed budget's July 1, 2027 UIS/PPS rate sensitivity.

Timeframe: Proposed state changes / work requirement phasing in 2026–2027Source: KPBS / San Diego County

ProjectedCoverage LossArkansasConfirmed count

About 210,000 ARHOME enrollees enter the work-requirement rollout

~210,000

Lives Impacted

—

Cost Estimate

Lives Impacted

ARHOME enrollees as of May 1, 2026; listed exemptions mean not every enrollee is subject to the 80-hour requirement

Cost Estimate · Who bears it

—

Individual Health

No sourced individual vignette is available in the cited announcement; the earlier gig-driver example was illustrative and has been removed.

Population Health

The Governor's Office reported about 210,000 ARHOME enrollees as of May 1. During the July-December 2026 soft launch DHS runs automated checks without penalties; enforcement begins January 1, 2027, and a member found out of compliance has 30 days to demonstrate compliance before suspension.

Timeframe: Soft launch July 1, 2026; enforcement begins January 1, 2027Source: Office of Governor Sarah Huckabee Sanders

ProjectedCoverage LossTennesseeModeled projection

Model projects 142,000–203,000 Tennesseans could forgo coverage after enhanced ACA credits expired

142,000–203,000

Lives Impacted

—

Cost Estimate

Lives Impacted

Tennesseans whom external scenario models allocated to the state project could forgo insurance coverage after enhanced Marketplace tax credits expired; this is not an observed disenrollment count

Cost Estimate · Who bears it

Not quantified by the source

Individual Health

No individual patient case is reported by the source. The earlier Memphis worker and Nashville-area FQHC vignette was synthetic and has been removed.

Population Health

Sycamore reported nearly 643,000 Tennessee Marketplace enrollees in 2025 and estimated 142,000–203,000 could forgo coverage after enhanced credits expired December 31, 2025. CMS later reported 569,310 Tennessee plan selections for 2026, but plan selections are not effectuated or full-year enrollment and cannot validate the projected coverage-loss range.

Timeframe: Projection for coverage effects after December 31, 2025; observed full-year 2026 losses are not yet establishedSource: The Sycamore Institute

In EffectCoverage LossFloridaConfirmed count

Florida ACA Marketplace Lost 196,643 Selections in 2026 Open Enrollment — Early Warning of Larger Erosion

~196,600

Lives Impacted

—

Cost Estimate

Lives Impacted

Florida ACA marketplace enrollees who dropped coverage in 2026 open enrollment before the full credit expiration impact

Cost Estimate · Who bears it

newly uninsured patients and FQHCs absorbing sliding-fee and uncompensated care

Individual Health

A 28-year-old agricultural worker in the Panhandle who dropped his marketplace plan when the premium crept up in 2026 now goes without coverage, likely turning to the nearest FQHC when a work injury or illness requires care.

Population Health

KFF data shows Florida dropped from 4,735,415 to 4,538,772 marketplace plan selections in 2026 open enrollment (−4.2%, −196,643), the largest absolute loss of any state — a leading indicator of the larger uninsured surge as enhanced credits fully expire.

Timeframe: 2026 open enrollment period; full impact materializing through 2026Source: KFF (Kaiser Family Foundation) State Health Facts

In EffectCoverage LossTexasTexasConfirmed count

Texas: 190,956 fewer children enrolled in Medicaid/CHIP than a year earlier — despite no change in eligibility

190,956 children

Lives Impacted

—

Cost Estimate

Lives Impacted

Texas had 190,956 fewer children enrolled in Medicaid/CHIP in February 2026 than in January 2025 (a 6% drop), even though Congress' Medicaid overhaul did not change children's eligibility — Georgetown CCF attributes the decline to paperwork friction, families assuming work requirements already apply, and an unwelcoming climate tied to immigration enforcement.

Cost Estimate · Who bears it

Texas children (coverage loss) and pediatric-serving Texas FQHCs (uncompensated care)

Individual Health

An eligible child dropped over paperwork misses well-child visits, immunizations, and early treatment, and often re-enters care uninsured at a Texas FQHC's sliding-fee scale.

Population Health

Texas already had the nation's highest rate of uninsured children — an estimated 1.1 million (13.6%) in 2024, roughly double the national rate — before these declines, deepening pediatric access gaps that Texas health centers must absorb.

Timeframe: February 2026 vs. January 2025Source: Axios San Antonio (Georgetown CCF analysis)

In EffectCoverage LossOhioConfirmed count

Ohio posts the nation's steepest ACA enrollment drop — 161,385 lose Marketplace coverage as subsidies expire

161,385 Ohioans (-32.4%, ~500,000 to 336,000)

Lives Impacted

Uncompensated-care increase not yet quantified

Cost Estimate

Lives Impacted

Ohio ACA Marketplace enrollees. Federal data reported July 9, 2026 show Ohio's Marketplace enrollment fell 32.4% — from roughly 500,000 to 336,000 — the largest percentage drop of any state, after enhanced premium tax credits expired January 1, 2026 and premiums roughly doubled.

Cost Estimate · Who bears it

Newly uninsured Ohioans and the FQHCs / safety-net providers absorbing them.

Individual Health

People priced out of Marketplace plans lose access to primary and preventive care; many will delay care until conditions become acute, then present uninsured at safety-net clinics and emergency rooms.

Population Health

A 32.4% coverage contraction concentrated in rural, lower-income counties raises Ohio's uninsured rate and shifts uncompensated-care burden onto FQHCs and safety-net providers with no offsetting revenue.

Timeframe: Enhanced premium tax credits expired January 1, 2026; enrollment decline reported July 9, 2026Source: Ohio Capital Journal

ProjectedCoverage LossKentuckyModeled projection

2025 KCEP analysis projected 149,000 Kentucky coverage losses from federal work-reporting rules

149,000 projected

Lives Impacted

Not quantified in source

Cost Estimate

Lives Impacted

Kentuckians projected by KCEP to lose Medicaid coverage because of work reporting, using Arkansas's experience as the basis for the estimate

Cost Estimate · Who bears it

The source projects coverage losses and reduced provider revenue but does not quantify an FQHC-specific uncompensated-care amount or a state budget shortfall attributable to the 149,000 estimate.

Individual Health

The source provides a statewide model, not an identified individual case; it does not establish that any specific Kentuckian has lost coverage under the future requirement.

Population Health

KCEP's July 2025 analysis projected 149,000 work-reporting-related Medicaid coverage losses, 210,000 people becoming uninsured because of Medicaid losses overall, and another 47,000 losing kynect coverage. These are separate modeled figures and should not be added as though they describe the same population.

Timeframe: Projection published July 11, 2025; the source described a future federal reporting requirement, not an observed loss countSource: Kentucky Center for Economic Policy

ProjectedCoverage LossLouisianaModeled projection

Two models, not one range: LDH projects 21,000 Medicaid losses; Urban estimates up to 132,000

21,000 LDH / up to 132,000 Urban

Lives Impacted

Not quantified

Cost Estimate

Lives Impacted

Louisiana adults projected to lose Medicaid under January 2027 federal community-engagement rules, using separate state and Urban Institute methods

Cost Estimate · Who bears it

People losing coverage and safety-net providers furnishing uncompensated care; the source does not quantify a Louisiana dollar total

Individual Health

A working Medicaid member can satisfy the activity rule yet still face closure if state data do not verify the activity and the member misses a mailed request for proof.

Population Health

Louisiana officials project about 21,000 coverage losses after accounting for work and likely exemptions. A separate Urban Institute model estimates up to 132,000 losses, including people who work or may qualify for an exemption but encounter documentation barriers.

Timeframe: Requirements begin January 1, 2027; the January renewal cohort received May 2026 notices and receives November 2026 packetsSource: NOLA.com / The Times-Picayune

ProjectedCost ShiftNebraskaModeled projection

Historical October 2025 KFF scenario modeled higher premiums for about 127,000 Nebraska tax-credit recipients

~127,000 exposed to modeled premium changes, not projected coverage losses

Lives Impacted

+$2,614/mo in one modeled household scenario

Cost Estimate

Lives Impacted

Nebraska marketplace enrollees receiving advance premium tax credits in the October 2025 analysis

Cost Estimate · Who bears it

Marketplace households if enhanced tax credits expired; amount varies by age, income, household, and location

Individual Health

KFF's scenario used a hypothetical 60-year-old couple in Nebraska's 3rd Congressional District earning $85,000; it was not a documented household outcome.

Population Health

Nebraska Public Media reported that about 127,000 Nebraskans were receiving advance marketplace tax credits. KFF modeled a 434% increase—from $602 to $3,216 per month—for one specified older-couple scenario if enhanced credits expired. The article did not estimate 15,000 Nebraska coverage losses, so the former 15,000-loss impact is retired rather than repeated.

Timeframe: Historical pre-expiration scenario published October 20, 2025 for potential 2026 premiums; not a current measured outcomeSource: Nebraska Public Media, reporting KFF analysis

ProjectedCoverage LossMarylandModeled projection

MDH Models About 115,000 Coverage Losses Under January 2027 Medicaid Work Requirements

~115,000 projected

Lives Impacted

—

Cost Estimate

Lives Impacted

ACA expansion adults within a group of more than 320,000 Maryland adults subject to the federal work requirement

Cost Estimate · Who bears it

Unknown; the MDH briefing does not quantify or assign Maryland-specific verification work, uncompensated care, or dollar effects to FQHCs or another provider group

Individual Health

The MDH briefing models an aggregate coverage-loss count but does not provide a patient vignette or identify a specific individual's hours, exemption status, verification pathway, or resulting clinical consequence.

Population Health

In its January 28, 2026 legislative briefing, MDH estimated that about 115,000 ACA expansion adults could lose coverage when work requirements begin January 1, 2027. The requirement applies to more than 320,000 adults, but that larger figure is the potentially subject population, not the projected loss count; MDH separately estimated about 15,000 noncitizen eligibility losses beginning October 1, 2026.

Timeframe: Work requirements and six-month redeterminations begin January 1, 2027; MDH planned initial written notices for August 2026Source: Maryland Department of Health

ProjectedCoverage LossConnecticutConnecticutModeled projection

Connecticut: ~110,000 HUSKY D adults at risk of losing Medicaid under federal work rules

~110,000

Lives Impacted

hundreds of millions/yr (hospitals)

Cost Estimate

Lives Impacted

About 35% of Connecticut's 316,000 HUSKY D (Medicaid expansion) enrollees, who must verify 80 hours/month of qualifying activity or an exemption by January 2027.

Cost Estimate · Who bears it

Connecticut hospitals and FQHCs absorbing uncompensated care; state administrative cost to build verification systems

Individual Health

A working adult whose hours fluctuate loses coverage over paperwork during a renewal, interrupting chronic-care medications managed at a community health center.

Population Health

CMS's June 1 interim final rule tightened the 'medical frailty' exemption (diagnosis plus significant impairment), so Connecticut now expects far fewer automatic exemptions than the 57,000 it had assumed.

Timeframe: Coverage terminations expected January 2027Source: CT Mirror / Connecticut Dept. of Social Services

ProjectedCoverage LossConnecticutModeled projection

Connecticut DSS says 110,000 HUSKY D adults are at risk under federal work rules

110,000 at risk

Lives Impacted

—

Cost Estimate

Lives Impacted

An estimated 35% of Connecticut's 316,000 HUSKY D adults without children; exempt members may remain covered and the final loss is unknown

Cost Estimate · Who bears it

—

Individual Health

The cited reporting identifies no individual patient; it describes an aggregate at-risk population and an unresolved exemption-review process.

Population Health

DSS estimated 110,000 HUSKY D adults were at risk when federal requirements begin in January 2027. A new two-part medical-frailty test could change the estimate, and officials said the ultimate coverage loss was not yet known.

Timeframe: Requirements begin in January 2027; final coverage loss remains unknownSource: CT Mirror

In EffectCost ShiftNevadaConfirmed count

CMS records 104,286 Nevada 2026 plan selections, including 85,980 with advance premium tax credits

104,286

Lives Impacted

$234/mo avg after APTC

Cost Estimate

Lives Impacted

Nevada consumers with a qualified health-plan selection during the 2026 Marketplace open-enrollment reporting period; this is not an effectuated-enrollment or coverage-loss count

Cost Estimate · Who bears it

Nevada 2026 Marketplace plan selectors; the amount is the reported average monthly premium after APTC, not an incremental increase

Individual Health

The official state-level public-use file is aggregate and does not identify an individual enrollee, so this entry does not create a synthetic enrollee story.

Population Health

CMS's 2026 state-level public-use file records 104,286 Nevada plan selections and 85,980 consumers with advance premium tax credits. The average gross monthly premium was $659 and the average premium after APTC was $234 across plan selectors; among APTC recipients, the average credit was $516 and the average remaining premium was $148. These are reported 2026 selection-period averages, not the change caused solely by expiration of enhanced credits.

Timeframe: 2026 Marketplace open-enrollment data reported through January 20, 2026Source: Centers for Medicare & Medicaid Services

ProjectedCoverage LossFederalModeled projection

H.R. 1 strips Medicare from ~100,000 lawfully present immigrants

~100,000

Lives Impacted

$1.1B/yr

Cost Estimate

Lives Impacted

Lawfully present immigrants — refugees, asylees, TPS holders, DV/trafficking survivors, some work-visa holders

Cost Estimate · Who bears it

California declines to backfill ~200,000 affected residents (~$1.1B/yr); the rest become uninsured/self-pay

Individual Health

An elderly refugee who paid into Medicare for years loses Part B and must self-pay or delay care for chronic conditions.

Population Health

Adds insured, often-elderly patients to FQHC self-pay panels nationwide starting January 2027 — California, with the most immigrant seniors, is the most exposed.

Timeframe: Disenrollment Jan 4, 2027Source: KFF Health News

In EffectAccess GapGeorgiaConfirmed count

Georgia Pathways to Coverage Enrolled Only ~8,000 of 100,000+ Eligible Adults in Two Years

100,000+

Lives Impacted

—

Cost Estimate

Lives Impacted

low-income uninsured Georgia adults eligible for Pathways but not enrolled, left in the coverage gap

Cost Estimate · Who bears it

uninsured low-income Georgians bearing out-of-pocket costs; FQHCs absorbing uncompensated care

Individual Health

A 45-year-old warehouse worker in Columbus earning $15,000/year is technically eligible for Pathways to Coverage but navigated the 80-hour documentation requirement incorrectly and was never enrolled, leaving the FQHC as his only source of care on a sliding-fee scale.

Population Health

Georgia's partial-expansion alternative enrolled just over 8,000 people — ~7% of eligible adults — after two years; GAO found two-thirds of spending went to administration (largely Deloitte), not care; state now projects only ~18,301 active enrollees by Dec 2026.

Timeframe: Two years of Pathways program operation through Dec 2025; extension to Dec 2026Source: Georgetown Center for Children and Families

ProjectedCoverage LossIndianaModeled projection

Hoosier Action projects 100,000+ additional Medicaid losses from 2026 state changes; FSSA disputes that an estimate is possible

100,000+

Lives Impacted

Not quantified for the 2026 measure

Cost Estimate

Lives Impacted

People Hoosier Action projects could lose Indiana Medicaid because of 2026 state changes; this is an advocacy projection disputed by FSSA

Cost Estimate · Who bears it

The article does not estimate patient costs, health-center revenue loss or savings caused by the 2026 measure

Individual Health

The cited article provides no individual patient vignette and does not say that a documentation gap automatically produces an uninsured FQHC visit.

Population Health

Hoosier Action projects more than 100,000 additional losses from state changes and nearly 400,000 by 2034 when state and federal changes are combined, mostly in the expansion population. FSSA said it had no estimate and questioned how anyone could produce one. The source does not validate the model independently or quantify an FQHC-specific effect.

Timeframe: Projection through 2034; source does not provide one effective date for all state and federal changesSource: WFYI Indianapolis

ProjectedCoverage LossOregonModeled projection

Healthier Oregon covers 100,000+ undocumented residents at ~$1.5B/biennium — now exposed to H.R.1 FMAP penalties

100,000+

Lives Impacted

~$1.5B/biennium

Cost Estimate

Lives Impacted

Oregon residents of all ages enrolled in Healthier Oregon regardless of immigration status; primarily immigrants who could not access the Oregon Health Plan before July 2023

Cost Estimate · Who bears it

Oregon General Fund (overwhelmingly state-funded with no federal match for undocumented residents); FMAP penalty risk could force program restructuring

Individual Health

A Mexican-born farmworker in the Willamette Valley who gained full Oregon Health Plan benefits through Healthier Oregon in 2023 and now manages her asthma at a community health center faces the risk that H.R.1 FMAP penalties prompt the legislature to cut or restructure the program in the 2026 budget reckoning.

Population Health

Healthier Oregon (full OHP benefits regardless of immigration status since July 2023) covers 100,000+ enrollees at ~$1.5B/biennium, predominantly state General Fund. H.R.1 imposes FMAP penalties on states that cover undocumented residents — a direct threat to the program's state-funded model and a major share of FQHC patient revenue.

Timeframe: Program under 2026 budget review; FMAP penalty risk ongoing under H.R.1Source: Oregon Legislature (OLIS) — OHA 2025-27 Budget Review

ProjectedCoverage LossNew MexicoModeled projection

NM models 88,530+ Medicaid coverage losses and a separate $8.5B federal provider-payment loss

at least 88,530

Lives Impacted

>$8.5B in federal funds, 2028–2037

Cost Estimate

Lives Impacted

New Mexicans projected by HCA to lose Medicaid coverage across the federal reconciliation law's eligibility changes; this is distinct from the 254,400 people projected to face added paperwork

Cost Estimate · Who bears it

New Mexico providers, patients and state financing absorb the effects of federal Medicaid funding no longer available for provider-payment arrangements; the source does not say the state will backfill the full amount

Individual Health

A Medicaid patient whose eligibility is affected may need a health center to verify an exemption, document activity, renew more often or connect to replacement coverage; the state projection does not identify a representative patient or outcome.

Population Health

HCA's August 2025 presentation separates at least 88,530 projected coverage losses from about 254,400 people exposed to added paperwork. It separately projects more than $8.5 billion in lost federal Medicaid funding from provider-payment changes alone during 2028–2037, more than 50 safety-net providers losing critical funding and six to eight likely rural-hospital closures in 18–24 months.

Timeframe: Eligibility changes begin in 2026 and 2027; the cited provider-payment funding projection covers 2028–2037Source: New Mexico Health Care Authority via New Mexico Legislature

In EffectCoverage LossCaliforniaConfirmed count

86,000+ undocumented Californians dropped or denied Medi-Cal in two months

86,000+

Lives Impacted

—

Cost Estimate

Lives Impacted

Undocumented Californians dropped or denied Medi-Cal, Jan–Feb 2026, after the enrollment freeze

Cost Estimate · Who bears it

Patients (lost coverage) + FQHCs (more uninsured visits)

Individual Health

A diabetic loses coverage and starts rationing insulin between paychecks.

Population Health

Exits ran at roughly 6x the normal rate; ~1.3M coverage loss is projected over four years.

Timeframe: Jan–Feb 2026 (ongoing)Source: KVPR / Public Health Watch

In EffectCost ShiftNew HampshireEstimate

Analyst estimates a 17.3% weighted-average gross-rate increase in New Hampshire's 2026 individual market

About 80,000 estimated individual-market enrollees

Lives Impacted

Not quantified

Cost Estimate

Lives Impacted

estimated total New Hampshire individual-market enrollment used in an analyst's weighted-rate calculation; not a confirmed count of coverage losses

Cost Estimate · Who bears it

Individual-market enrollees before tax credits; the analysis does not quantify net-premium changes or health-center uncompensated-care costs.

Individual Health

The rate analysis does not identify an individual enrollee or calculate any person's net premium after tax credits.

Population Health

ACA Signups calculated a 17.3% weighted-average gross-rate increase from final New Hampshire carrier filings and estimated or redacted carrier enrollment. The approximately 80,000 figure is an estimate of the full individual market, not the official Marketplace plan-selection count and not a count of people who became uninsured. Gross rate change and net premium change after tax credits are different measures.

Timeframe: Final gross-rate changes for plan year 2026; analysis published November 1, 2025Source: ACA Signups analysis of New Hampshire rate filings

ProposedCoverage LossUtahConfirmed count

Utah projected 75,204 AEM enrollees in its still-pending community-engagement amendment

75,204 projected enrollees; losses not quantified

Lives Impacted

Not quantified

Cost Estimate

Lives Impacted

Projected Adult Expansion Medicaid enrollment for demonstration year 25, not a projected or observed disenrollment count

Cost Estimate · Who bears it

The application projects AEM expenditures but does not quantify patient costs, FQHC revenue loss, or uncompensated care caused by the proposal

Individual Health

The application describes suspension and eventual loss of eligibility for a nonexempt member who does not complete the proposed activities, but it does not provide a named patient vignette or quantify how many people would reach that outcome.

Population Health

Utah projected 75,204 AEM enrollees, estimated that 89.5% would meet an exemption, and assumed about 50% compliance among people without an exemption or good cause. It did not publish a resulting coverage-loss estimate. The proposed July 1, 2026 start passed while CMS continued to list the amendment as pending.

Timeframe: Requested July 1, 2026 start did not take effect; CMS still listed the amendment as pending on July 15, 2026Source: Utah Department of Health and Human Services / Centers for Medicare & Medicaid Services

In EffectCoverage LossTexasTexasConfirmed count

Texas: 73,000+ more children under 6 are uninsured — the under-6 uninsured rate jumped from 7.9% to 10.8% in two years

73,000+ additional uninsured children under 6

Lives Impacted

—

Cost Estimate

Lives Impacted

Texas children under age 6 without health insurance: the rate rose from 7.9% (2022) to 10.8% (2024) per Georgetown CCF analysis of 2024 American Community Survey data, while the national under-6 rate rose from 4.3% to 5.3%. Researchers tie the deterioration to the Medicaid unwinding (2M+ Texans lost coverage, ~1.7M for procedural reasons); Texas 2036 estimates about half of the state's uninsured children are Medicaid-eligible but unenrolled. NOTE: this survey-based stock measure and the separately tracked 190,956-child Medicaid/CHIP enrollment decline (Feb 2026 vs Jan 2025) describe overlapping populations from different datasets — do not add them.

Cost Estimate · Who bears it

Texas young children (coverage loss) and pediatric-serving Texas health centers (uncompensated care)

Individual Health

An uninsured toddler misses well-child visits, immunizations, and developmental screenings in the years when they matter most.

Population Health

Texas already has the nation's highest child uninsured burden; a rising under-6 rate deepens the early-childhood access gap that pediatric-serving Texas health centers absorb on sliding-fee schedules.

Timeframe: 2022 vs. 2024 (2024 ACS data; reported June 1, 2026)Source: Texas Public Radio (Georgetown CCF research)

In EffectAccess GapCaliforniaCaliforniaEstimate

California: Medi-Cal enrollment among undocumented adults falls nearly 71,000 amid an immigration-enforcement chilling effect

~71,000

Lives Impacted

—

Cost Estimate

Lives Impacted

Undocumented and mixed-status adults in California's expansion Medi-Cal whose enrollment fell; UCLA LPPI attributes roughly one-third (~22,900) of the drop to an immigration-enforcement chilling effect rather than eligibility or trend changes.

Cost Estimate · Who bears it

California FQHCs (lost Medi-Cal reimbursement plus rising uncompensated care)

Individual Health

A farmworker parent stops renewing Medi-Cal out of deportation fear, skips diabetes refills and prenatal visits, and shifts from a routine sliding-fee FQHC visit to delayed or emergency care.

Population Health

FQHCs serving immigrant communities lose insured patients and per-visit Medi-Cal revenue even as clinical need persists — compounding the same centers' July 1, 2027 UIS/PPS sensitivity exposure.

Timeframe: Enrollment decline through early 2026; UCLA LPPI data brief June 23, 2026Source: UCLA Latino Policy & Politics Institute (LPPI)

In EffectWorkforce LossIndianaEstimate

Indiana FQHCs HealthLinc and Heart City Health merge to survive Medicaid cuts amid reports of 50-100 layoffs statewide

~68,000 patients across the two merging FQHCs; 'a handful' of IN health centers cutting 50-100 staff

Lives Impacted

Operating losses not disclosed; 'incredibly thin margins' cited by leadership

Cost Estimate

Lives Impacted

Patients of Valparaiso-based HealthLinc (~57,000 patients, 14 clinics) and Elkhart-based Heart City Health (~11,000 patients, 4 clinics), which announced a merger to stabilize staffing and access. HealthLinc's CEO said federal and state Medicaid cuts have made it hard to retain staff and that 'in Indiana alone' she had recently heard of a handful of health centers laying off 50 to 100 people and closing sites; Indiana's Medicaid work requirement takes effect in October.

Cost Estimate · Who bears it

Indiana FQHCs operating on thin margins and their Medicaid patients.

Individual Health

Consolidation aims to keep clinics staffed and open in Elkhart and the broader Michiana area, but the underlying Medicaid squeeze threatens appointment availability and continuity of care for low-income patients.

Population Health

The merger is an early example of Medicaid-cut-driven FQHC consolidation nationally: even historically stable health centers are cutting positions and closing sites, reducing safety-net capacity in the communities that rely on them most.

Timeframe: Merger announced the week of July 13, 2026; Indiana Medicaid work requirement effective October 2026Source: WVPE (NPR / Indiana Public Broadcasting)

In EffectAccess GapMississippiModeled projection

Families USA model estimates Mississippi expansion could cover 67,000 people and preserve $73.8M in 2026 state resources

67,000 modeled

Lives Impacted

$73.8M modeled 2026 state fiscal loss

Cost Estimate

Lives Impacted

people Families USA modeled as gaining coverage if Mississippi expanded Medicaid

Cost Estimate · Who bears it

Mississippi through forgone premium-tax revenue and state health spending that federal expansion funds could cover

Individual Health

The source identifies no individual person, diagnosis, visit or outcome; the 67,000 figure is a statewide policy-model estimate.

Population Health

Medicaid-expansion bills died without committee action in the 2026 session. A Families USA model cited by Mississippi Today estimated that expansion could cover 67,000 people; this is not an observed coverage-gap count or measured FQHC volume.

Timeframe: 2026 legislative session and Families USA 2026 fiscal modelSource: Mississippi Today

ProjectedCoverage LossArkansasModeled projection

Arkansas flags 63,792 Medicaid expansion enrollees as 'not compliant' in a July soft launch of its work requirement

63,792 flagged 'not compliant' (of 192,399 checked); state projects ~42,000 will lose coverage

Lives Impacted

Revenue/coverage loss not yet quantified in dollars

Cost Estimate

Lives Impacted

ARHOME (Arkansas Medicaid expansion) enrollees. In a July 1, 2026 soft launch, the Department of Human Services ran automated checks on 192,399 enrollees: 22.7% were confirmed compliant, 44.1% exempt, and 33.2% (63,792) were notified they are 'currently not meeting' the 80-hour/month work-or-activity requirement. Full enforcement begins Jan. 1, 2027, when anyone determined non-compliant loses coverage unless they demonstrate compliance within 30 days. In its April 30 waiver-renewal application the state itself projected the requirement will shrink ARHOME enrollment about 20% (roughly 42,000 people).

Cost Estimate · Who bears it

Arkansas Medicaid enrollees (coverage) and the FQHCs and safety-net providers that serve them (uncompensated care).

Individual Health

Enrollees flagged non-compliant who cannot navigate the reporting and documentation process risk losing coverage in 2027 — the same dynamic that dropped about 18,000 Arkansans during the state's 2018 work-requirement experiment before a federal court halted it.

Population Health

Arkansas is the first state to implement a work requirement under the 2025 federal law (One Big Beautiful Bill Act), which requires every Medicaid-expansion state to adopt one. FQHCs and safety-net clinics absorb the resulting coverage churn as uncompensated care and lost revenue as patients cycle off Medicaid.

Timeframe: Soft launch July 1, 2026; notices sent July 2026; full enforcement January 1, 2027Source: Arkansas Democrat-Gazette

ProjectedCost ShiftSouth CarolinaModeled projection

KFF projection cited by SC Public Radio estimates up to $5B less Medicaid funding and 60,000 fewer enrollees

up to 60,000 fewer enrollees

Lives Impacted

up to $5B over 10 years

Cost Estimate

Lives Impacted

Projected reduction in South Carolina Medicaid enrollment over ten years; this is a modeled estimate cited by the report

Cost Estimate · Who bears it

Projected reduction in South Carolina Medicaid funding; the report does not allocate the full amount among the state, providers, and patients

Individual Health

The cited report provides no named patient vignette and does not project that Allendale County Hospital will close within a specified number of years.

Population Health

South Carolina Public Radio reports a 10% annual phase-down of state-directed payments for ten years beginning in 2028. Citing KFF, it says South Carolina could lose up to $5 billion in Medicaid funding and have 60,000 fewer enrollees over the period. The report describes Allendale County Hospital's near-zero operating margin but does not quantify demand transferred to FQHCs.

Timeframe: State-directed payment phase-down begins in 2028 and continues at 10% per year for ten yearsSource: South Carolina Public Radio

ProjectedCoverage LossMichiganModeled projection

~52,000 Michigan Health-Center Patients to Lose Medicaid; Centers Face $38.3M Annual Revenue Loss

~52,000

Lives Impacted

$38.3M/yr

Cost Estimate

Lives Impacted

Community health center patients statewide projected to lose Medicaid coverage under H.R. 1 work requirements (effective January 1, 2027)

Cost Estimate · Who bears it

Michigan community health centers absorbing lost Medicaid reimbursement as covered patients become uninsured

Individual Health

A part-time warehouse worker in Wayne County who cycles between gig work and UI will find it nearly impossible to document a consistent 80 qualifying hours every month — and will lose the Healthy Michigan Plan coverage that pays for her asthma inhalers.

Population Health

A May 2025 MDHHS report found ~52,000 health-center patients statewide could lose Medicaid coverage, cutting ~$38.3 million in annual health-center revenue — nearly 30% of the federal Health Center Program grant funding Michigan receives. Medicaid covers 51% of Michigan health-center patients and 63% of service revenue.

Timeframe: Work requirements effective January 1, 2027; MDHHS outreach must begin by September 30, 2026Source: Michigan Department of Health & Human Services (via MPCA)

ProjectedCoverage LossDelawareModeled projection

DHA Projects More Than 50,000 Delaware Medicaid Coverage Losses

>50,000 projected

Lives Impacted

$3B–$5B over 10 years (KFF estimate)

Cost Estimate

Lives Impacted

Delaware residents projected by the Delaware Healthcare Association to lose Medicaid coverage under enacted federal changes

Cost Estimate · Who bears it

Delaware's federal Medicaid financing base; the cited analysis does not assign a specific amount to FQHCs, the state budget, or individual providers

Individual Health

The cited reporting provides aggregate projections and general examples of delayed care; it does not document a named FQHC patient or an observed individual coverage loss.

Population Health

WHYY reported two distinct estimates: the Delaware Healthcare Association projected more than 50,000 Medicaid coverage losses and more than 30,000 additional uninsured residents, while KFF estimated a 14% reduction in Delaware's federal Medicaid funding totaling about $3 billion to $5 billion over ten years. The estimates come from different organizations, are forward-looking, and must not be added together as observed losses.

Timeframe: Projected over ten years under enacted federal Medicaid changes; no single Delaware loss date is suppliedSource: WHYY reporting KFF and Delaware Healthcare Association estimates

In EffectCoverage LossColoradoConfirmed count

Colorado CHCs served 38,000 more uninsured patients while two-thirds posted negative 2024 margins

+38,000 uninsured CHC patients (2021–2024)

Lives Impacted

—

Cost Estimate

Lives Impacted

Additional uninsured patients served by Colorado community health centers in 2024 compared with 2021

Cost Estimate · Who bears it

—

Individual Health

CCHN says many patients who lost Medicaid during the unwind continued to receive community-health-center care, with sliding-fee discounts available to eligible uninsured or underinsured patients.

Population Health

CCHN reports a 29% increase in uninsured CHC patients from 2021 to 2024, two-thirds of Colorado centers with negative 2024 operating margins, and an estimated increase in the CHC share of the state's uninsured population from 34% to 48%.

Timeframe: Observed from 2021 through calendar year 2024; reported November 24, 2025Source: Colorado Community Health Network (CCHN)

ProjectedCoverage LossIdahoModeled projection

Idaho adopts a three-month Medicaid work-history lookback; federal-change model estimates a 20,000–34,000 enrollment reduction

20,000–34,000 modeled enrollment reduction

Lives Impacted

Not quantified

Cost Estimate

Lives Impacted

Upper-bound modeled reduction among Idaho's roughly 80,000 Medicaid expansion enrollees by 2028 from federal Medicaid changes, including community-engagement rules

Cost Estimate · Who bears it

The cited analysis does not quantify uncompensated-care costs or assign a verified dollar impact to Idaho health centers.

Individual Health

An applicant subject to the rule must document qualifying activity for three consecutive months before enrollment unless an exemption applies. The source does not document a specific patient's loss of care.

Population Health

Gov. Brad Little signed HB 913 on April 10, 2026. Urban Institute and Robert Wood Johnson Foundation modeling cited by Idaho Capital Sun estimates that federal Medicaid changes, including work requirements, could reduce Idaho expansion enrollment by 20,000 to 34,000 people by 2028; the upper bound is about 44% of the roughly 80,000-person group.

Timeframe: State adoption required by December 31, 2026; federal implementation begins January 1, 2027; enrollment effect modeled through 2028Source: Spokane Public Radio / Idaho Capital Sun

In EffectCoverage LossIllinoisConfirmed count

Illinois ends immigrant adult coverage (HBIA) July 2025 — ~33,000 routed to FQHCs uninsured

~33,000

Lives Impacted

~$330M/yr state savings

Cost Estimate

Lives Impacted

Non-citizen adults aged 42–64 who lost Medicaid-equivalent coverage when Illinois closed HBIA on June 30, 2025 and were directed to FQHCs as uninsured patients

Cost Estimate · Who bears it

Illinois FQHCs bear the uncompensated care cost; the state captured ~$330M in annual savings by eliminating HBIA for ages 42–64

Individual Health

A 55-year-old immigrant woman in Chicago who previously had full Medicaid coverage through HBIA now presents at her FQHC without insurance — her hypertension medications and follow-up labs become uncompensated care the health center must absorb.

Population Health

Illinois closed HBIA (aged 42–64) effective June 30, 2025 — a ~$330M state savings (HFS spent $487M on HBIA in FY24); the April 2025 provider notice explicitly redirected ~33,000 former enrollees to FQHCs and free clinics regardless of immigration status.

Timeframe: In effect since July 1, 2025; ongoing uncompensated care burden for Illinois FQHCsSource: Illinois HFS (Healthcare & Family Services)

In EffectCost ShiftNorth CarolinaNorth CarolinaConfirmed count

North Carolina kills a Medicaid SDOH pilot that a new study shows saved $164/member/month

~31,000

Lives Impacted

$164/member/mo saved (forgone)

Cost Estimate

Lives Impacted

High-needs Medicaid enrollees in 3 rural NC regions who lost Healthy Opportunities Pilot services (food, housing, transportation)

Cost Estimate · Who bears it

NC Medicaid forgoes proven savings; patients and FQHCs/rural providers absorb the avoidable utilization

Individual Health

A diabetic patient who relied on the pilot's food-and-transport support loses both and returns to the ED for preventable crises.

Population Health

A UNC Sheps Center study (June 2, 2026) found the pilot cut ED visits, hospitalizations, and costs by $164/member/month vs. controls — yet NC defunded it (CMS authorization ran through 2029); ECU Health cut 31 jobs in the wind-down.

Timeframe: Defunded 2025; savings study published June 2, 2026Source: NC DHHS / UNC Sheps Center

ProjectedCoverage LossMaineModeled projection

Maine Projects 31,000+ First-Year MaineCare Disenrollments Under Federal Work Rules

31,000+

Lives Impacted

~$8M first-year

Cost Estimate

Lives Impacted

Approximately 90,000 MaineCare expansion adults subject to an 80-hours-per-month work, volunteering or half-time education requirement, with 31,000 or more projected to disenroll in year one

Cost Estimate · Who bears it

State technology and staffing investment needed to implement the federal eligibility-verification requirements

Individual Health

A member with seasonal or unpredictable work can remain substantively eligible yet lose coverage if monthly work activity or an exclusion cannot be verified; Maine DHHS identifies documentation hurdles and heritage-industry seasonality as drivers of its projection.

Population Health

Maine DHHS projects 31,000 or more first-year disenrollments after the work-and-community-engagement rule takes effect December 31, 2026. It estimates $8 million in fiscal-year 2027 technology and staffing investment and about $5.5 million annually thereafter.

Timeframe: Work-and-community-engagement rule effective December 31, 2026; $8 million estimate applies to fiscal year 2027Source: Maine DHHS

In EffectClinic Closure / Funding CliffOregonLane CountyConfirmed count

Lane County FQHC cuts 23 jobs and closes 2 of 8 clinics

~30,000

Lives Impacted

$6.5M deficit (by FY2027-28)

Cost Estimate

Lives Impacted

Patients of Community Health Centers of Lane County as the FQHC consolidates from 8 sites to 6

Cost Estimate · Who bears it

Community Health Centers of Lane County

Individual Health

With two clinics closing, a patient travels farther and waits longer for primary care, and 23 staff lose their roles.

Population Health

23 positions eliminated (15 filled), 8 clinic sites consolidated to 6, ~30,000 patients affected — driven by 340B cuts, a CCO transition, lapsed ACA tax credits, and looming Oregon Medicaid losses.

Timeframe: FY2026-27 into FY2027-28Source: Lookout Eugene-Springfield

ProjectedCoverage LossNew HampshireModeled projection

Urban Institute projects 14,000–29,000 fewer New Hampshire Medicaid expansion enrollees in 2028

14,000–29,000

Lives Impacted

Not quantified

Cost Estimate

Lives Impacted

modeled reduction in New Hampshire Medicaid expansion enrollment in an average month of 2028 under combined federal work-requirement and six-month-redetermination policies

Cost Estimate · Who bears it

The analysis does not quantify a New Hampshire patient cost, health-center revenue loss, or uncompensated-care amount.

Individual Health

The Urban Institute model does not identify an individual patient or predict which specific enrollee would lose coverage.

Population Health

The model projects 14,000 fewer average-month expansion enrollees in 2028 under a higher-mitigation scenario and 29,000 fewer under a lower-mitigation scenario. It combines the effects of federal work requirements and six-month eligibility redeterminations and is not an observed 2026 loss count.

Timeframe: Modeled average-month enrollment in 2028; federal community-engagement implementation begins no later than January 1, 2027Source: Urban Institute

In EffectAccess GapAmerican SamoaConfirmed count

American Samoa health center applicant reports 26,056 unduplicated patients in 2024

26,056

Lives Impacted

Not quantified

Cost Estimate

Lives Impacted

Unduplicated UDS-countable patients reported for calendar year 2024 by American Samoa Community Health Center in its federal Service Area Competition abstract

Cost Estimate · Who bears it

No cost or funding-loss amount is asserted by this patient-count record

Individual Health

The federal award record contains an aggregate, applicant-provided patient count and does not identify an individual patient; no representative person or clinical outcome is inferred.

Population Health

The applicant describes American Samoa's only HRSA-funded health center as reaching 26,056 unduplicated UDS-countable patients in 2024 through seven permanent clinics, one intermittent site, and a behavioral-health mobile unit. The abstract says this was more than half the territory's population. It does not independently validate every UDS field, quantify unmet need, or estimate the effect of a future funding change.

Timeframe: Calendar year 2024 patient count reported in the current federal award abstractSource: HHS TAGGS / HRSA (applicant-provided award abstract)

In EffectBenefit CutColoradoConfirmed count

HB26-1411 limits dental benefits and conditionally caps enrollment at 25,000 children

25,000-child conditional enrollment cap

Lives Impacted

—

Cost Estimate

Lives Impacted

Certain children under 19 who meet the income rules and are ineligible for Medicaid because of immigration status

Cost Estimate · Who bears it

—

Individual Health

Beginning January 1, 2027, a child in the affected group who was not already receiving specified long-term services by December 31, 2026 will not be eligible for those services; children already receiving them are grandfathered.

Population Health

The enacted law caps annual dental services at $1,100 beginning July 1, 2026 and, beginning January 1, 2027, moves behavioral health to fee-for-service and ends managed-care coverage for the affected population. The 25,000-child enrollment cap begins only after an enrollment or quarterly-spending trigger and a 60-day interval.

Timeframe: Dental cap began July 1, 2026; remaining benefit and enrollment provisions begin January 1, 2027 subject to statutory conditionsSource: Colorado General Assembly

ProjectedCoverage LossRhode IslandModeled projection

EOHHS preliminary model places about 24,600 Medicaid members at risk and estimates a $49.7M FY2027 payment reduction

~24,600 at risk

Lives Impacted

$49.7M modeled FY2027 payment reduction

Cost Estimate

Lives Impacted

Medicaid members in a November 2025 EOHHS preliminary budget model assumed to be at risk of disenrollment under community-engagement requirements; this is not an observed or guaranteed loss count

Cost Estimate · Who bears it

Modeled reduction in Rhode Island Medicaid capitation and other payments, including $5.0M in state general revenue; no FQHC-specific allocation is published

Individual Health

The testimony provides no named or representative patient case. It models eligibility closures in aggregate and therefore does not support a synthetic worker, diagnosis, medication interruption or health-center utilization story.

Population Health

EOHHS estimated 32,000 people would be subject to the requirements and assumed 75%, about 24,600, would be at risk. The FY2027 model spreads assumed closures across February-July 2027 and estimates a $49.7M reduction in Medicaid payments. Inputs were preliminary and subject to federal guidance.

Timeframe: Preliminary FY2027 model assumes closures distributed from February through July 2027Source: Rhode Island Executive Office of Health and Human Services

In EffectCoverage LossConnecticutConnecticutConfirmed count

Connecticut: 22,000+ lost ACA coverage for nonpayment in the first half of 2026 — a 75% jump as enhanced subsidies expire

22,000+ (H1 2026, +75% YoY)

Lives Impacted

~$115M one-time state offset; net premiums +14% to +21%

Cost Estimate

Lives Impacted

Access Health CT enrollees who lost marketplace coverage after failing to pay premiums once enhanced federal premium tax credits expired; 63% of surveyed lapsed enrollees found other coverage, meaning roughly 37% ended up uninsured.

Cost Estimate · Who bears it

Connecticut's emergency response fund (one-time offset) and enrollees (higher net premiums)

Individual Health

A patient who drops an unaffordable Marketplace plan returns to a community health center as a self-pay/sliding-fee patient, often deferring care.

Population Health

Nonpayment losses surged 75% even though Gov. Lamont allocated about $115M from the state's emergency response fund to offset subsidy loss for the lowest-income enrollees — with no guaranteed funding for 2027 and net monthly premiums up an average of 14% for an individual and 21% for a family of four.

Timeframe: First half of 2026Source: CT Mirror (Access Health CT data)

In EffectAccess GapMicronesiaConfirmed count

Four reporting FSM Health Center Program awardees served 19,791 patients in 2024

19,791

Lives Impacted

Not quantified

Cost Estimate

Lives Impacted

Unique patients aggregated by HRSA across four reporting FSM Health Center Program awardees in the 2024 Uniform Data System

Cost Estimate · Who bears it

Not quantified in the cited 2024 UDS overview

Individual Health

The aggregate UDS record identifies no individual patient and should not be presented as an individual closure or coverage-loss story.

Population Health

HRSA reports 19,791 total patients in 2024: 14,000 uninsured, zero Medicaid/CHIP, zero Medicare and 5,791 with other third-party coverage. These are reported payer categories, not proof that a clinic closed or that any patient lost care.

Timeframe: Calendar year 2024 UDS reporting periodSource: Health Resources and Services Administration Uniform Data System

ProposedBenefit CutConnecticutConfirmed count

June 2025 federal proposal threatened CT coverage for 15,600 children and 3,200 postpartum women

~18,800 (15,600 kids + 3,200 women)

Lives Impacted

~$41M/yr

Cost Estimate

Lives Impacted

Income-eligible undocumented children under 15 and postpartum women in Connecticut covered by state-only 'HUSKY for immigrants' at 100% state cost

Cost Estimate · Who bears it

Connecticut paid the reported children and postpartum costs; the article described a proposed additional federal penalty

Individual Health

The cited article identifies no individual enrollee or care site; it reports statewide enrollment and cost estimates.

Population Health

As of April 2025, about 15,600 children and 3,200 postpartum women had state-funded coverage, with estimated FY2025 costs of $30 million and $11 million respectively. The penalty was a proposal in the federal bill then under negotiation, not an enacted outcome established by this source.

Timeframe: Enrollment and FY2025 cost snapshot; federal proposal status as of June 11, 2025Source: CT Mirror

In EffectCoverage LossArkansasConfirmed count

2018 precedent: 18,000 Arkansans lost Medicaid in seven months

~18,000

Lives Impacted

—

Cost Estimate

Lives Impacted

Medicaid expansion enrollees subject to Arkansas's 2018 work-reporting rule

Cost Estimate · Who bears it

—

Individual Health

CBPP reports that some people did not learn their coverage had ended until they sought care or tried to fill a prescription; it does not document the earlier farmworker vignette.

Population Health

CBPP documents that about 18,000 people — one in four of those subject to the rule — lost coverage in the first seven months. It describes exemption, notice, administrative, phone-access, and online-portal failures, but does not support the withdrawn 97% figure.

Timeframe: Historical (2018); cited as 2026 predictive baselineSource: Center on Budget and Policy Priorities

In EffectAccess GapGeorgiaConfirmed count

Georgia's Pathways work-requirement program reaches just 16,782 as 1 in 3 low-income adults stay uninsured

16,782 enrolled vs. an estimated 200,000-300,000 in the coverage gap

Lives Impacted

$110M spent through June 2025 (<1/3 on actual care)

Cost Estimate

Lives Impacted

Low-income Georgia adults eligible for 'Pathways to Coverage,' the nation's only active Medicaid work-requirement program. As of April 30, 2026 it had enrolled just 16,782 people; 60% of applications were denied in its first two years and 64% of renewals lapsed for paperwork reasons rather than ineligibility.

Cost Estimate · Who bears it

Georgia and federal taxpayers (mostly administrative / eligibility-system costs); uninsured patients and the FQHCs serving them bear the coverage gap.

Individual Health

Eligible adults who cannot clear the 80-hour/month activity documentation go without coverage and rely on FQHCs and free clinics for care — a live preview of the federal work requirement reaching 40+ expansion states by January 2027.

Population Health

After two years, Pathways covers a small fraction of the eligible pool while roughly 1 in 3 low-income Georgia adults remain uninsured, leaving FQHCs as the default source of primary care for the coverage gap.

Timeframe: Program launched July 2023; enrollment data as of April 30, 2026; spending through June 2025Source: Georgians for a Healthy Future

In EffectCoverage LossRhode IslandConfirmed count

16,000 existing HealthSource RI customers exited 2026 plans; net enrollment fell about 9,500

~16,000 plan exits

Lives Impacted

No aggregate cost reported

Cost Estimate

Lives Impacted

Existing HealthSource RI customers reported to have dropped 2026 marketplace coverage; about 6,500 new customers partly offset those exits, leaving a net decline of about 9,500

Cost Estimate · Who bears it

The article documents higher premiums and lower health-center revenue per uninsured patient but does not calculate a statewide dollar cost

Individual Health

The article documents Barbosa, a 48-year-old Pawtucket housekeeper with high blood pressure and diabetes, whose Silver-plan premium rose from $224 to $250 per month. She dropped the plan and applied for a health-center sliding-fee discount. Her case is reported evidence, not a profile of all 16,000 plan exits.

Population Health

About 16,000 existing customers exited and about 6,500 new customers enrolled, producing a net decline of about 9,500, or 20% from 48,000 at the start of open enrollment. RIHCA separately projects that health centers' uninsured share could rise from about 9% to 18%-20%; that percentage is not an observed result.

Timeframe: Observed during the 2026 open-enrollment period ending January 31, 2026; reported March 9, 2026Source: Ocean State Media

In EffectAccess GapU.S. Virgin IslandsConfirmed count

USVI's two 2024 Health Center Program awardees served 15,297 patients; 26.36% were uninsured

15,297

Lives Impacted

Not quantified

Cost Estimate

Lives Impacted

patients reported across two U.S. Virgin Islands Health Center Program awardees in the 2024 Uniform Data System

Cost Estimate · Who bears it

Not quantified by this UDS patient-count source

Individual Health

The aggregate UDS record identifies no individual patient and cannot establish any one person's coverage, access or clinical outcome.

Population Health

HRSA reports 15,297 patients in 2024: 6,465 (42.26%) were Medicaid/CHIP patients, 4,033 (26.36%) were uninsured and 15,056 were at or below 200% of the federal poverty guideline among patients with known income.

Timeframe: Calendar-year 2024 Uniform Data System reporting periodSource: Health Resources and Services Administration

ProjectedCoverage LossAlaskaModeled projection

9,452–13,611 Alaska expansion enrollees modeled to lose Medicaid under community-engagement rules

9,452–13,611

Lives Impacted

—

Cost Estimate

Lives Impacted

Modeled Medicaid expansion enrollees among the 18,905 people whom existing state data may not automatically verify as exempt or compliant

Cost Estimate · Who bears it

—

Individual Health

An expansion enrollee whose exemption or qualifying activity cannot be verified from existing data must complete a manual process; the model assumes some people in that group lose coverage, but it does not identify a representative person or reason for each loss.

Population Health

Using 61,169 expansion enrollees ages 19–64 as a 2027 proxy, Manatt estimates 42,267 could be automatically verified and 18,905 would need a manual process. The two scenarios assume 50% or 72% of that manual group loses coverage, producing 9,452 or 13,611 losses; these are modeled scenarios, not observed disenrollments.

Timeframe: Model addresses implementation beginning in 2027; the report says Alaska could receive a good-faith waiver delaying implementation for up to two yearsSource: Alaska Department of Health / Manatt Health

In EffectAccess GapPalauConfirmed count

Palau's 2024 Health Center Program awardee reported 13,144 patients, including 12,300 without third-party medical insurance

13,144

Lives Impacted

$4,205,074 reported total cost

Cost Estimate

Lives Impacted

Unique patients reported by Palau's one Health Center Program awardee in the 2024 UDS aggregate

Cost Estimate · Who bears it

The 2024 UDS aggregate reports total cost but does not assign that amount to a payer or establish a Compact-versus-HRSA funding share.

Individual Health

No individual patient is identified in the aggregate UDS record; this entry does not invent a patient vignette.

Population Health

HRSA reports 13,144 total patients, 12,300 without third-party medical insurance (93.58%), 10,602 at or below the federal poverty guideline, and one reporting awardee. These are awardee-reported service and payer counts, not Palau's population, clinic visits, uncompensated-care cost, or proof that the awardee is every resident's only primary-care option.

Timeframe: 2024 UDS reporting periodSource: Health Resources and Services Administration — 2024 Uniform Data System

In EffectCoverage LossCaliforniaVentura CountyConfirmed count

Ventura County: 13,000+ residents dropped Medi-Cal since October — nearly 6% of enrollment — with 10,000 more projected by year-end

13,000+ since October (nearly 6%); ~10,000 more projected

Lives Impacted

—

Cost Estimate

Lives Impacted

Ventura County Medi-Cal enrollees who dropped coverage between October 2025 and May 2026, per Gold Coast Health Plan — attributed to immigration-enforcement fear, renewal and enrollment changes, and coming H.R. 1 provisions; the plan projects 10,000 more could drop out by the end of the year. More than 227,000 county residents — about 1 in 4 — are covered by Medi-Cal.

Cost Estimate · Who bears it

Patients (coverage loss) and Ventura County safety-net clinics (uncompensated care)

Individual Health

A family that drops Medi-Cal out of fear skips preventive visits and returns to care later, sicker, as self-pay patients at safety-net clinics.

Population Health

About 65% of patients in Ventura County's county-run safety-net system are insured through Medi-Cal — the disenrollment wave converts insured visits into uncompensated care across the county's clinics.

Timeframe: October 2025 - May 2026 (reported May 10, 2026)Source: Ventura County Star (Gold Coast Health Plan data)

ProjectedCoverage LossNevadaModeled projection

NVPCA models 13,000 FQHC Medicaid losses, $17M in annual revenue, and 107 FTE jobs at risk

~13,000

Lives Impacted

$17M/yr

Cost Estimate

Lives Impacted

FQHC patients whom the Nevada Primary Care Association estimated could lose Medicaid coverage under the federal changes; this is a modeled projection, not a confirmed disenrollment count

Cost Estimate · Who bears it

Nevada FQHC network under the NVPCA operating-revenue model

Individual Health

The cited testimony did not identify an individual patient outcome, so this entry does not create a synthetic patient story.

Population Health

NVPCA testimony reported by Nevada Current modeled about 13,000 FQHC patients losing Medicaid, approximately $17 million in annual revenue loss equal to 11% of operating revenue, and an estimated 107 full-time-equivalent jobs. Nevada Medicaid Administrator Ann Jensen separately estimated 70,000 statewide coverage losses based on a 50% drop-off observed elsewhere.

Timeframe: Modeled for federal community-engagement requirements that CMS says generally begin January 1, 2027, unless a state chooses an earlier dateSource: Nevada Current via News From The States

ProjectedCoverage LossWyomingModeled projection

A pre-enactment estimate projected at least 12,000 coverage losses; a separate REMI scenario modeled ~$140M less GDP

12,000 projected

Lives Impacted

~$140M modeled GDP reduction over 2026-2030

Cost Estimate

Lives Impacted

At least 12,000 Wyoming coverage losses in a pre-enactment Families USA projection based on the House-passed federal bill; not a confirmed count or a REMI output

Cost Estimate · Who bears it

Wyoming's modeled economy; REMI also modeled 192 fewer jobs per year on average and $14.6M less annual disposable personal income

Individual Health

Neither the advocates' statewide coverage projection nor the REMI economic scenario identifies an individual patient or proves that a particular resident will lose coverage or use an FQHC.

Population Health

A Families USA fact sheet based on the House-passed federal bill projected that at least 12,000 Wyoming residents could lose coverage. Separately, a commissioned REMI scenario prepared while federal cuts were still a possibility modeled about $140 million less cumulative state GDP over 2026-2030, an average of 192 fewer jobs per year, and $14.6 million less disposable personal income annually. Both analyses predate final federal law, use different analytic bases, and remain projections rather than observed final-law effects.

Timeframe: Analyses prepared before final federal law; REMI model years 2026-2030Source: WyoFile

In EffectBenefit CutCaliforniaCentral CoastConfirmed count

Santa Barbara County: the $9.2M Public Health cut reaches ~10,400 patient-visits a year across pharmacy, phlebotomy, and specialty lines

~10,440 patient-visits/yr (non-additive lines)

Lives Impacted

$9.2M FY2026-27 ($8.46M pharmacy + $533K phlebotomy + $231K specialties)

Cost Estimate

Lives Impacted

Patients of Santa Barbara County's Public Health clinics under the $9.2 million FY2026-27 cut approved unanimously June 16, effective July 1: pharmacy consolidation from three sites to one (Lompoc stays; Santa Maria and Santa Barbara close — roughly 1,942 patients affected annually in Santa Maria; $8.46M of the savings; three pharmacists and six pharmacy technicians, seven of nine positions filled); phlebotomy removed from Santa Maria and Lompoc (~3,220 Santa Maria + ~4,486 Lompoc patients/yr; $533K; 4.5 FTE, 3.5 filled); and nephrology, urology, neurology, and GI dropped at the Santa Barbara Health Center (~792 patients/yr; $231K). Lines overlap — do not sum as unique people.

Cost Estimate · Who bears it

Santa Barbara County Public Health patients (access) and staff (positions)

Individual Health

A Santa Maria patient who filled prescriptions at the county pharmacy now travels to Lompoc or moves to a commercial pharmacy; a lab draw becomes a separate trip to a contracted lab.

Population Health

The county attributes the cuts to changes in federal and state policies regarding who qualifies for Medi-Cal; the July 12 partial reversal (15 clinic positions restored with $6.6M from the state PPS delay) restored staffing but left the pharmacy, phlebotomy, and specialty externalizations in place.

Timeframe: Approved June 16, 2026; effective July 1, 2026Source: Santa Maria Sun

ProjectedCost ShiftNebraskaModeled projection

HCAN modeled 10,000 fewer FQHC patients and more than $33M in lost revenue under proposed Medicaid reductions

~10,000 modeled fewer patients

Lives Impacted

$33M+ modeled

Cost Estimate

Lives Impacted

Nebraska FQHC patients in HCAN's modeled exposure to proposed Medicaid spending changes

Cost Estimate · Who bears it

Nebraska FQHCs under HCAN's modeled revenue-loss scenario

Individual Health

The UNMC report provides no individual patient case for this estimate; the earlier synthetic farmworker vignette is removed.

Population Health

UNMC's report on potential Medicaid cuts cites HCAN's estimate that proposed changes in Medicaid spending would produce 10,000 fewer Nebraska FQHC patients and more than $33 million in lost revenue. The report presents modeled exposure, not a measured result of enacted policy, and warns that rural safety-net providers would be especially vulnerable.

Timeframe: Potential impact modeled in a UNMC report revised June 2025; no measured effective dateSource: UNMC Center for Health Policy, citing Health Center Association of Nebraska

In EffectCost ShiftVermontEstimate

Vermont reports 9,272 fewer federal-subsidy recipients, a 2,358 enrollment decline and an estimated $72M federal-fund reduction

9,272 fewer federal-subsidy recipients

Lives Impacted

$72M estimated collective federal-fund reduction

Cost Estimate

Lives Impacted

Vermont Health Connect members receiving federal subsidies compared with September 2025; this is not a count of confirmed coverage losses

Cost Estimate · Who bears it

Vermont marketplace enrollees collectively; the source does not quantify an FQHC cost

Individual Health

The cited reporting provides aggregate enrollment and subsidy measures and does not document an individual premium increase, coverage loss or move to FQHC sliding-fee care.

Population Health

Vermont Health Connect enrollment declined by 2,358; 9,272 fewer members received federal subsidies than in September 2025; and 6,216 current members received no state or federal subsidy, up from just over 1,600 the prior year.

Timeframe: Enhanced credits ended after 2025; measures reported April 23, 2026Source: VTDigger

In EffectCoverage LossDistrict of ColumbiaConfirmed count

October 2025 Alliance changes reduced enrollment by about 8,600 by early 2026

~8,600

Lives Impacted

—

Cost Estimate

Lives Impacted

Alliance members no longer enrolled after tighter eligibility, the enrollment moratorium, and fear of immigration enforcement

Cost Estimate · Who bears it

—

Individual Health

The cited reporting documents patients losing covered medicines, dental care, physical therapy, and procedures after the 2025 changes; it does not support the prior synthetic insulin vignette, which has been removed.

Population Health

The 51st reported that Alliance enrollment fell from 27,600 to about 19,000 by the first quarter of 2026, a decline of roughly 8,600 attributed to tighter eligibility, the enrollment moratorium, and fear of immigration enforcement.

Timeframe: Measured from the October 1, 2025 changes through the first quarter of 2026Source: The 51st, citing DHCF and DC Health Benefit Exchange officials

In EffectAccess GapGuamConfirmed count

Guam's 2024 HRSA Health Center awardee served 8,595 patients; 71.8% were Medicaid/CHIP patients

8,595

Lives Impacted

Not quantified

Cost Estimate

Lives Impacted

patients reported by Guam's one Health Center Program awardee across its reporting scope in the 2024 Uniform Data System

Cost Estimate · Who bears it

Not quantified by this UDS patient-count source

Individual Health

The aggregate UDS record identifies no individual patient and cannot establish any one person's coverage, access, or clinical outcome.

Population Health

HRSA reports 8,595 patients in 2024: 6,171 (71.80%) were Medicaid/CHIP patients and 1,390 (16.17%) were uninsured. Among patients with known income, 7,797 were at or below 200% of the federal poverty guideline.

Timeframe: 2024 Uniform Data System reporting periodSource: Health Resources and Services Administration

In EffectAccess GapWyomingConfirmed count

HRSA's 2024 baseline records 6,434 uninsured patients at Wyoming's five reporting health-center awardees

6,434 uninsured patients

Lives Impacted

No revenue loss established

Cost Estimate

Lives Impacted

Uninsured patients served in 2024 by Wyoming's five reporting Health Center Program awardees

Cost Estimate · Who bears it

The HRSA record reports $9,587,935 in Medicaid collections; it does not report a 2024 Medicaid revenue loss.

Individual Health

HRSA's UDS tables provide aggregate annual counts and collections. They do not identify an individual patient, document reduced clinic hours, or attribute a capital or staffing decision to the payer mix.

Population Health

Five Wyoming Health Center Program awardees reported 34,666 patients in 2024, including 6,434 uninsured patients and 7,005 Medicaid/CHIP patients. Table 9D reports $9,587,935 in Medicaid collections, 35.15% of patient-related collections. The prior 14.8% 'Medicaid revenue decline' was a field misread: 14.80% was the Medicare share, not a year-over-year Medicaid decline.

Timeframe: Calendar year 2024 UDS reporting periodSource: Health Resources and Services Administration

In EffectCoverage LossWyomingConfirmed count

CMS records 5,098 fewer final Wyoming Marketplace plan selections for 2026 than for 2025

5,098 fewer selections

Lives Impacted

Not quantified

Cost Estimate

Lives Impacted

Difference between Wyoming's 46,643 final Qualified Health Plan selections for 2025 and 41,545 for 2026

Cost Estimate · Who bears it

CMS's enrollment files do not quantify a Wyoming patient, provider, insurer, or state cost from the selection-count difference.

Individual Health

The CMS files measure plan selections during two annual enrollment periods. They do not establish that any identified Wyoming resident became uninsured, effectuated or ended coverage, or sought care at a health center.

Population Health

Final Wyoming Marketplace plan selections decreased by 5,098, or 10.9%, from 46,643 for 2025 to 41,545 for 2026. This is an observed selection-count change, not a confirmed coverage-loss or uninsured-person count; Mountain Health CO-OP exit, premium, and clinic-flow effects require separate evidence.

Timeframe: 2025 and 2026 final Open Enrollment Period filesSource: Centers for Medicare & Medicaid Services

In EffectAccess GapMarshall IslandsConfirmed count

RMI's one reporting health-center awardee served 5,051 patients in 2024

5,051

Lives Impacted

$2,943,094 reported total cost

Cost Estimate

Lives Impacted

Patients reported by RMI's one 2024 Health Center Program awardee; UDS classifies all 5,051 as uninsured in its third-party coverage categories

Cost Estimate · Who bears it

UDS reports health-center cost but does not assign a payer for this impact; all patients are in its uninsured category

Individual Health

HRSA publishes an aggregate state-level record and identifies no individual patient; it reports 397 patients with diabetes and 199 with HbA1c above 9% or no test during 2024.

Population Health

The awardee served 5,051 patients in 2024, down from 6,321 in 2023. UDS reports no Medicaid, CHIP, Medicare, other public, or private third-party coverage for these patients; that is an awardee-reported insurance classification, not a claim that RMI residents lack every domestic health-financing arrangement.

Timeframe: Calendar-year 2024 UDS reporting periodSource: Health Resources and Services Administration, Uniform Data System

In EffectAccess GapNorthern Mariana IslandsConfirmed count

CNMI's One Health Center Program Awardee Served 3,786 Patients in 2024

3,786

Lives Impacted

Not quantified

Cost Estimate

Lives Impacted

patients served in 2024 by CNMI's one reporting Health Center Program awardee

Cost Estimate · Who bears it

Not quantified by the cited UDS source

Individual Health

HRSA's aggregate UDS record identifies no individual patient and does not establish that any named person lost care.

Population Health

HRSA reports one CNMI Health Center Program awardee and 3,786 total patients served in the 2024 UDS reporting period. This is a confirmed service count, not a count of people affected by the Medicaid cap.

Timeframe: Calendar year 2024 UDS reporting periodSource: Health Resources and Services Administration, 2024 Uniform Data System

In EffectCoverage LossDistrict of ColumbiaConfirmed count

About 2,200 people losing Medicaid did not qualify for Healthy DC in the January 2026 transition

~2,200

Lives Impacted

—

Cost Estimate

Lives Impacted

DC residents who lost Medicaid at the lower adult income limit and were not eligible for Healthy DC

Cost Estimate · Who bears it

—

Individual Health

No sourced individual profile is available for this specific 2,200-person group; the evidence supports the transition count and outreach gap, not a fabricated patient story.

Population Health

About 17,000 residents lost Medicaid on January 1, 2026. Roughly 15,000 transferred to Healthy DC, while about 2,200 qualified for neither program; the Exchange reported reaching only about 300 of that latter group by late March.

Timeframe: Coverage change effective January 1, 2026; outreach count reported in late March 2026Source: The 51st, citing DC Health Benefit Exchange officials

In EffectClinic Closure / Funding CliffNew HampshireConfirmed count

Ammonoosuc closes its Franconia clinic, which served about 1,400 patients

About 1,400

Lives Impacted

$500,000 projected network shortfall

Cost Estimate

Lives Impacted

patients served by the Franconia clinic from Franconia, Easton, Lincoln, and Sugar Hill

Cost Estimate · Who bears it

Ammonoosuc Community Health Services, according to its CEO; he said closing the clinic would save about $250,000

Individual Health

The report identified Susan Bushby, 70, who said changing health centers would be frustrating and worried about losing relationships with her providers; it did not report a measured clinical outcome.

Population Health

Associated Press reported that Ammonoosuc Community Health Services closed the Franconia clinic in October 2025. CEO Edward Shanshala attributed a projected $500,000 network shortfall to Medicaid reductions and said the closure would save about $250,000. Those financial causes are attributed statements, while the approximately 1,400-patient site count is reported directly.

Timeframe: Clinic closed in October 2025; source published November 23, 2025Source: Associated Press via EMS1

In EffectCoverage LossNebraskaModeled projection

Bluestem models 10%–15% Medicaid disenrollment and $400K–$600K annual revenue exposure

~840–1,260 modeled at Bluestem

Lives Impacted

$400K–$600K/yr modeled at Bluestem

Cost Estimate

Lives Impacted

Bluestem Medicaid patients the CEO estimated could eventually be disenrolled, based on a 10%–15% scenario applied to about 8,400 patients

Cost Estimate · Who bears it

Bluestem Health through modeled lost Medicaid revenue and greater uncompensated care

Individual Health

The source contains no documented individual patient profile; the earlier synthetic meatpacking-worker story is removed.

Population Health

Before Nebraska's May 1 launch, Bluestem Health CEO Brad Meyer reported about 8,400 Medicaid patients and estimated that 10%–15% could eventually be disenrolled, or roughly 840–1,260 people. He modeled a $400,000–$600,000 annual loss and said the real financial effect would not be known until 2027. These are one FQHC's projections, not observed statewide terminations.

Timeframe: Work requirement effective May 1, 2026; Bluestem said actual financial impact would not be known until 2027Source: 10/11 NOW via WOWT, reporting Bluestem Health

ProjectedCoverage LossSouth DakotaModeled projection

DSS Models 1,213 Medicaid Expansion Disenrollments Under January 2027 Community-Engagement Rules

~1,213 modeled

Lives Impacted

—

Cost Estimate

Lives Impacted

Modeled Medicaid expansion disenrollments: DSS identified 6,066 recipients who appeared subject to community-engagement rules and assumed 20% would neither qualify for an exemption nor meet the criteria

Cost Estimate · Who bears it

No FQHC cost or uncompensated-care amount is quantified in the DSS source

Individual Health

The DSS model does not identify 1,213 named people or describe their occupations, race, health conditions, or clinic use. A nonexempt expansion enrollee must meet a qualifying pathway and may need to provide documentation if the state cannot verify it electronically; American Indian and Alaska Native enrollees are exempt.

Population Health

At the April 23, 2026 Medicaid Advisory Committee meeting, DSS presented a planning estimate based on available data. It said 6,066 expansion recipients appeared subject to the requirement and modeled 1,213 disenrollments by applying a 20% noncompliance-or-no-exemption assumption. The slide notes incomplete data and overlapping exemptions, so the figure is a projection rather than an observed or confirmed count.

Timeframe: Community-engagement requirements begin January 1, 2027; DSS planned initial notices for September 2026, while actual eligibility actions depend on implementation and individual reviewSource: South Dakota Department of Social Services

In EffectWorkforce LossHawaiiConfirmed count

Hawaiʻi's Geography-Adjusted Physician Supply Gap Reached 833 FTEs in 2025

833 FTE supply gap

Lives Impacted

—

Cost Estimate

Lives Impacted

full-time-equivalent physician supply gap after accounting for island geography; 833 is not a count of patients or literal open job postings

Cost Estimate · Who bears it

Neighbor-island patients face travel and access burdens; provider-level cost is not quantified

Individual Health

The article reports that neighbor-island patients face longer waits and may have to travel to Oʻahu for specialty and increasingly primary care, with travel costs not always covered. It does not establish that Molokaʻi has no resident physician or that an FQHC is the island's entire care system.

Population Health

The 2025 assessment found a 644-FTE statewide shortage before geography and an 833-FTE gap after island-specific needs were considered. Hawaiʻi County lacked 224 physicians, Maui 179 and Maui primary care 45; more than 88 physicians moved away and at least 81 retired in 2025.

Timeframe: 2025 workforce assessment reported January 8, 2026Source: Honolulu Civil Beat

In EffectClinic Closure / Funding CliffKansasEstimate

Latest cited model classifies 69 Kansas rural hospitals at risk and 28 at immediate risk

69 hospitals modeled at risk

Lives Impacted

Not quantified

Cost Estimate

Lives Impacted

Rural Kansas communities served by hospitals classified as financially at risk in the June 2026 CHQPR model

Cost Estimate · Who bears it

The cited report describes access and financial risk; it does not quantify an FQHC cost transfer

Individual Health

The classification signals financial vulnerability, but it does not mean a named hospital has announced closure. Patients should use current hospital and emergency-service notices rather than the model alone for care planning.

Population Health

KCUR reports that CHQPR classified 69 of about 100 analyzed Kansas rural hospitals as at risk and 28 as at immediate risk. Kansas Hospital Association cautioned that the model does not include every local city or county tax subsidy.

Timeframe: Model reported June 11, 2026; not a closure announcementSource: KCUR / Kansas News Service / CHQPR

In EffectClinic Closure / Funding CliffIowaConfirmed count

Iowa reports 54 facilities with OB units and 43 OB-unit closures since 2000

43 OB units closed

Lives Impacted

Not quantified in source

Cost Estimate

Lives Impacted

Iowa obstetric units reported closed since 2000; this is a facility count, not a patient count

Cost Estimate · Who bears it

The report does not quantify patient travel costs, provider financial losses, or FQHC uncompensated care

Individual Health

The cited legislative report provides no individual patient vignette and does not state a typical travel distance after a closure.

Population Health

As of December 1, 2025, Iowa HHS reported 54 facilities with obstetric units and 43 unit closures since 2000, including two closures during 2024. The report does not state that Iowa leads the nation or quantify demand shifted to FQHCs.

Timeframe: Cumulative closures since 2000; facility status reported as of December 1, 2025Source: Iowa Department of Health and Human Services / Iowa General Assembly

ProposedCost ShiftKentuckyModeled projection

Pre-enactment model identified 35 Kentucky rural hospitals as financially vulnerable under proposed Medicaid cuts

35 hospitals identified

Lives Impacted

Not quantified for the 35 hospitals

Cost Estimate

Lives Impacted

Thirty-five Kentucky hospitals meeting the Sheps Center's vulnerability criteria; this is a facility count, not a patient count or a forecast that all 35 will close

Cost Estimate · Who bears it

The article said Kentucky could lose up to $28 billion in federal Medicaid funding under the proposal then before Congress, but it did not assign that amount to the 35 hospitals or quantify an FQHC cost shift.

Individual Health

The source does not identify a patient who lost access because of a hospital closure; it presents a pre-enactment hospital-risk screen.

Population Health

A UNC Sheps Center method identified hospitals both in the top 10% nationally for reliance on Medicaid payments and with negative operating margins over the prior three years: 338 nationally, including 35 in Kentucky.

Timeframe: Analysis published June 17, 2025 before final federal enactment; no hospital closure date was projectedSource: Kentucky Center for Economic Policy

In EffectClinic Closure / Funding CliffIowaConfirmed count

River Hills Community Health Center lays off 24 as two Iowa sites close July 31 — the confirmed headcount behind a closure announced in the spring

24 health center workers lose their jobs (19 Centerville, 5 Richland Dental); patient count not published

Lives Impacted

Not quantified — no payroll, patient-revenue, or transition-cost figure published

Cost Estimate

Lives Impacted

Twenty-four employees of River Hills Community Health Center, a Section 330 health center in southeast Iowa — 19 at the Centerville clinic and 5 at Richland Dental. Staff were notified July 17, 2026 and the layoffs take effect July 31. The organization attributed the closures to 'ongoing financial and operational challenges affecting rural health care across Iowa and the nation.' NO PATIENT COUNT HAS BEEN PUBLISHED, so the number of people losing their usual source of care is not yet known — the 24 figure counts workers, not patients, and should never be presented as the population impact.

Cost Estimate · Who bears it

The 24 laid-off workers and their households; patients who must travel farther or defer care; remaining River Hills sites absorbing redirected demand.

Individual Health

In rural southeast Iowa the closing site is frequently the only nearby primary care or dental option. Patients face a longer drive, a new provider relationship, or deferral — and dental is typically the first service people simply drop when it moves out of reach.

Population Health

This closes a documented gap in our own Iowa record, which noted that earlier sources did not report affected headcount. It is also a concrete instance of the pattern the sector keeps forecasting: rural health center consolidation driven by margin pressure rather than by any single policy. River Hills is separately tracked in the labor file over a Teamsters Local 90 unfair-labor-practice charge alleging the closure timing was anti-union retaliation — those are allegations, unresolved, and the closure and the ULP should be read as two distinct threads.

Timeframe: Staff notified July 17, 2026; layoffs and site closures effective July 31, 2026Source: KYOU-TV

In EffectClinic Closure / Funding CliffGeorgiaEstimate

Up to 22 Rural Georgia Hospitals at Risk of Closure, 9 at Immediate Risk, Pushing Demand Onto FQHCs

22 hospitals

Lives Impacted

—

Cost Estimate

Lives Impacted

rural Georgians who will lose hospital services and shift to FQHCs as their primary care source

Cost Estimate · Who bears it

rural Georgians and FQHCs absorbing displaced hospital patients

Individual Health

A pregnant woman in Lavonia lost access to her local labor-and-delivery unit when Sacred Heart Hospital closed it in 2025, now required to travel nearly an hour to Athens for prenatal and delivery care — with no FQHC maternity services to fill the gap.

Population Health

Chartis Center for Rural Health flagged ~22 rural Georgia hospitals at risk of closure (9 at immediate risk); 9 rural hospitals have already closed since 2010; instability shifts primary, dental, and behavioral health demand onto Georgia's 30+ FQHCs.

Timeframe: Ongoing closures since 2010; accelerating under 2025-2026 Medicaid cutsSource: Georgia Recorder

In EffectClinic Closure / Funding CliffVirginiaConfirmed count

Eight school-based health clinics closed in Southwest Virginia by July 2026

8 school-based clinics

Lives Impacted

~$400K projected 340B-savings decline; not a direct cut

Cost Estimate

Lives Impacted

School-based clinic sites closed in Bristol and Washington and Smyth counties; the source does not quantify unique patients

Cost Estimate · Who bears it

The cited projection applies to the Southwest Virginia clinic coalition and is not a measured public appropriation cut, patient cost, or final organization-level loss

Individual Health

The source does not publish a patient profile or establish the outcome for any individual student. Families should verify current school and health-center alternatives rather than infer that every affected student lost all access to care.

Population Health

Virginia Mercury reported that FQHC operators closed eight school-based clinics serving Bristol and Washington and Smyth counties. The clinics had been supported by reinvested 340B savings; the state primary care association said the Southwest Virginia clinic coalition's approximately $2.7 million in annual 340B savings was projected to decline by about $400,000. The report documents eight closures, but it does not provide a unique-patient count or allocate the projected decline among policy, manufacturer, volume, or other causes.

Timeframe: Closures reported July 10, 2026; the source does not publish one effective date for all eight sitesSource: Virginia Mercury, citing Virginia Community Healthcare Association

In EffectCost ShiftMinnesotaConfirmed count

CMS defers $199M in federal Medicaid funds from Minnesota, part of a $1.07B two-state action with California

Not quantified in lives — this is a state-financing action

Lives Impacted

$199M deferred from Minnesota ($1.067B combined with California's $867.5M)

Cost Estimate

Lives Impacted

No individual coverage loss has been announced. The deferral withholds federal matching funds from the Minnesota Medicaid program pending documentation; it does not by itself terminate anyone's eligibility. Minnesota Medicaid director John Connolly said CMS 'has not provided data or explanation on how the deferral amount was calculated.' CMS Administrator Oz cited claims in 'high-risk categories' that states had not documented acceptably.

Cost Estimate · Who bears it

Minnesota Department of Human Services / state general fund, pending resolution of the documentation dispute with CMS.

Individual Health

No direct clinical consequence at the individual level yet — this is a financing dispute upstream of care. It belongs in the tracker because sustained deferrals are how state budget pressure begins, and rate actions are what follow.

Population Health

Minnesota had already absorbed a $350M deferral earlier in 2026, and California a $1.3B one, so this is a pattern rather than an isolated action. For health centers the signal is that federal matching funds are now a contested, documentation-dependent revenue line for their state payer — the kind of uncertainty that shows up in the next rate cycle.

Timeframe: Deferral reported July 21, 2026; follows earlier 2026 deferrals of $350M (MN) and $1.3B (CA)Source: Healthcare Dive

In EffectClinic Closure / Funding CliffVirginiaSouthwest VirginiaConfirmed count

Southwest Virginia loses all eight school-based health clinics after a $2.3M collapse in 340B funding

8 clinics closed

Lives Impacted

$2.3M (340B loss, 3.5 yrs)

Cost Estimate

Lives Impacted

Students, staff, and families across Smyth and Washington counties and the city of Bristol who used eight school-based clinics operated by Southwest Virginia Community Health Systems (an FQHC); the clinics are closing ahead of the 2026-27 school year.

Cost Estimate · Who bears it

Southwest Virginia Community Health Systems (FQHC) and the patients losing access

Individual Health

A rural student whose only accessible primary care was the on-campus clinic now faces a long drive and a gap in care for asthma, immunizations, or behavioral health.

Population Health

Eight fewer access points in an already care-scarce rural region; the FQHC attributes the closures to roughly $2.3 million in 340B losses over 3.5 years.

Timeframe: Clinics closing ahead of the 2026-27 school yearSource: WCYB / Southwest Virginia Community Health Systems

ProjectedRate CutKentuckyConfirmed count

Kentucky cuts Medicaid provider rates 4% on August 1 — about $200M less per year across 46 provider types

46 provider types

Lives Impacted

~$200M/yr

Cost Estimate

Lives Impacted

Kentucky Medicaid fee-for-service providers across 46 provider types — including waiver programs for ventilator-dependent people and people with intellectual/developmental disabilities — and the patients whose access those rates sustain.

Cost Estimate · Who bears it

Kentucky Medicaid providers (including FQHCs and disability/elder-care waiver programs)

Individual Health

A Kentucky patient on a disability waiver may wait longer for care as providers absorb a 4% cut on already-thin margins.

Population Health

Lower reimbursement pressures safety-net capacity statewide while waitlists for waiver services already stretch into the tens of thousands.

Timeframe: Effective August 1, 2026Source: WEKU (NPR)

In EffectCoverage LossFederalConfirmed count

National: Medicaid + ACA Marketplace enrollment has fallen by more than 5 million in 12 months (observed)

>5M (observed YoY)

Lives Impacted

—

Cost Estimate

Lives Impacted

A Georgetown CCF / Protect Our Care analysis finds Medicaid/CHIP enrollment down ~3.8M and ACA Marketplace plans down ~1.2M over 12 months. This is the observed national aggregate that sits behind the mechanism-specific entries tracked separately (ACA enhanced-PTC expiration and Medicaid work requirements) — it is NOT additive to those.

Cost Estimate · Who bears it

Patients (coverage loss) and FQHCs nationwide (uncompensated care)

Individual Health

A patient who falls off both Medicaid (over paperwork) and a now-unaffordable Marketplace plan returns to an FQHC uninsured, on the sliding-fee scale.

Population Health

North Carolina and Ohio are among the states with the steepest ACA drops (>10%); the combined contraction expands the uninsured pool FQHCs are legally required to serve, ahead of Medicaid work-requirement enforcement beginning January 1, 2027.

Timeframe: Observed over the 12 months through mid-2026Source: NBC News / Georgetown CCF / Protect Our Care

In EffectCoverage LossFederalModeled projection

ACA enhanced premium tax credits expired — 2026 Marketplace enrollment falls and net premiums roughly double

Millions

Lives Impacted

~+114% net premiums

Cost Estimate

Lives Impacted

ACA Marketplace enrollees nationwide after the enhanced premium tax credits lapsed December 31, 2025; KFF documents sharp 2026 enrollment declines as out-of-pocket premium payments rise roughly 114%.

Cost Estimate · Who bears it

Marketplace enrollees (higher premiums) and FQHCs (uncompensated care as patients drop coverage)

Individual Health

A self-employed Marketplace patient whose net premium jumps ~114% drops coverage mid-year and returns to an FQHC as a sliding-fee, uninsured patient.

Population Health

FQHCs nationwide absorb a growing uninsured Marketplace population on top of Medicaid reductions, raising uncompensated-care burden at every health center.

Timeframe: Enhanced credits expired Dec 31, 2025; effects through the 2026 plan yearSource: KFF

ProjectedCost ShiftMichiganMichiganModeled projection

Michigan health centers will lose ~$94M/year under H.R. 1

~700K patients

Lives Impacted

$94M/yr

Cost Estimate

Lives Impacted

Patients of Michigan's ~700,000-patient FQHC network, already operating on negative margins

Cost Estimate · Who bears it

Michigan FQHCs (lost Medicaid reimbursement under H.R. 1)

Individual Health

As clinics cut services to absorb the reimbursement hole, a rural Michigan patient loses a nearby primary-care option and delays care.

Population Health

The Michigan Primary Care Association pegs the statewide reimbursement loss at $94M/year — a threat to safety-net access statewide; Gov. Whitmer's FY2026 budget secured $2.7B in federal health funding as a partial buffer.

Timeframe: Annual, as H.R. 1 Medicaid cuts phase inSource: Michigan Primary Care Association

ProjectedRate CutCaliforniaCentral CoastEstimate

Central Coast FQHCs: model UIS/PPS exposure before 2027 guidance lands

Center-specific

Lives Impacted

Model locally

Cost Estimate

Lives Impacted

Each FQHC's State-Only/UIS patient panel and visit mix; do not borrow an outside local count without primary-source verification

Cost Estimate · Who bears it

Each FQHC's operating budget

Individual Health

A patient keeps coverage on paper, but the clinic must know whether reimbursement changes would threaten access, staffing, or service mix.

Population Health

Turns the signed-budget delay into a 2027 sensitivity exercise: UIS visits by service line, current PPS rates, applicable fee-schedule or managed-care rates, and final DHCS guidance.

Timeframe: Deferred to July 1, 2027 — 2026-27 budget signed June 29, 2026Source: California Department of Health Care Services

ProjectedCost ShiftCaliforniaLos AngelesConfirmed count

LA County DHS: $700M federal revenue decline by 2029 + 3 health centers consolidated

3 centers

Lives Impacted

$700M by 2029

Cost Estimate

Lives Impacted

Patients of the Antelope Valley, Torrance, and East LA county health centers being consolidated

Cost Estimate · Who bears it

LA County Health Services (federal revenue decline)

Individual Health

A patient who used the East LA county center now travels farther and waits longer for the same visit.

Population Health

LA's public safety net contracts under a hiring freeze as federal revenue falls — displaced patients flow to nearby FQHCs.

Timeframe: FY26-27 → 2029Source: Los Angeles County

In EffectCost ShiftCaliforniaLos AngelesConfirmed count

LA's Measure ER officially passed — 1,013,747 yes votes create a ~$1B/yr safety-net tax

LA safety net

Lives Impacted

$1B/yr

Cost Estimate

Lives Impacted

Los Angeles County safety-net patients who would benefit from the local backstop

Cost Estimate · Who bears it

Local sales tax revenue after implementation

Individual Health

LA FQHCs should now plan bridge timing, allocation documentation, and uninsured-care reporting before revenue begins flowing October 1.

Population Health

The official final count was 1,013,747 yes (50.64%) to 987,977 no (49.36%); the half-cent sales tax is expected to raise roughly $1B/yr after taking effect October 1, 2026.

Timeframe: Takes effect October 1, 2026Source: Los Angeles County Registrar-Recorder/County Clerk

ProjectedCost ShiftCaliforniaModeled projection

MCO-tax June 30 CMS cliff threatens the Medi-Cal rate floor (~$1.1B GF)

Medi-Cal rate floor

Lives Impacted

$1.1B GF

Cost Estimate

Lives Impacted

Medi-Cal primary-care, maternal-care, and behavioral-health rate floors FQHCs rely on

Cost Estimate · Who bears it

California General Fund (if CMS withholds the extension)

Individual Health

If the rate floor lapses, the supplemental payments that keep specialty and BH access viable shrink.

Population Health

CMS approved the current MCO tax only through June 30; the budget merely assumes a Dec-31 extension.

Timeframe: Transition expires June 30, 2026Source: California Legislative Analyst's Office

In EffectAccess GapCaliforniaConfirmed count

Only 16% of California's Medi-Cal kids got an eye exam

16% screened

Lives Impacted

$47 rate (frozen 25 yrs)

Cost Estimate

Lives Impacted

Children on Medi-Cal — only 16% received an eye exam (2022-24), down from 19%

Cost Estimate · Who bears it

Optometrists (frozen rate) → access denied to kids

Individual Health

A child's undiagnosed vision problem goes uncorrected, hurting reading and classroom learning.

Population Health

Pediatric eye-exam rates fell as the ~$47 Medi-Cal exam rate stayed frozen 25 years and the May Revision excluded optometry.

Timeframe: 2022–2024 dataSource: CalMatters / California Optometric Association

In EffectAccess GapCaliforniaConfirmed count

Fewer than 6,000 of ~15M Medi-Cal members used the CHW benefit

<6,000

Lives Impacted

<$1M reimbursed

Cost Estimate

Lives Impacted

Medi-Cal beneficiaries who actually accessed the Community Health Worker benefit since 2022

Cost Estimate · Who bears it

An underused funded benefit (foregone navigation capacity)

Individual Health

Patients miss the trusted-messenger navigation that keeps them enrolled and in care.

Population Health

A funded benefit reaching under 0.04% of those eligible — exactly when navigation demand is spiking. AB 403 would force public reporting from July 2027.

Timeframe: Since July 2022Source: California Legislature (AB 403) / Latino Coalition for a Healthy California

In EffectAccess GapCaliforniaLos AngelesConfirmed count

Koreatown patients are delaying or dropping care after losing coverage

Koreatown patients

Lives Impacted

—

Cost Estimate

Lives Impacted

Immigrant patients at a Los Angeles FQHC reporting they now skip or postpone needed care

Cost Estimate · Who bears it

Patients (delayed care) + FQHCs (sicker patients, later)

Individual Health

A patient who lost Medi-Cal puts off a needed visit until a manageable problem becomes an emergency.

Population Health

Coverage loss is translating into measurable care-avoidance in immigrant communities — the demand-side mirror of the enrollment freeze.

Timeframe: May 2026 (ongoing)Source: American Community Media

In EffectCost ShiftTexasConfirmed count

Texas loses $600M+ in federal public-health funds as OBBBA + pandemic streams expire

Public-health programs

Lives Impacted

$600M+

Cost Estimate

Lives Impacted

Texans served by immunization, HIV/STI prevention, and infectious-disease programs FQHCs refer to

Cost Estimate · Who bears it

Texas public-health system

Individual Health

Cuts to immunization and HIV/STI programs reach the same low-income patients FQHCs serve and refer.

Population Health

Immunization funds more than halved; ~$90M off HIV/STI prevention; Dallas County laid off 21 public-health staff and Bell County closed a clinic.

Timeframe: 2025–2026Source: Texas Medical Association

ProjectedClinic Closure / Funding CliffTexasConfirmed count

Community Health Center Fund extended only through Dec 2026 — Texas's 71 grantees on a short clock

71 grantees

Lives Impacted

$4.6B (through Dec 2026)

Cost Estimate

Lives Impacted

Patients of Texas's 71 Section 330 grantee health centers facing repeated short-term funding cliffs

Cost Estimate · Who bears it

Federal Section 330 grant base (Texas's 71 grantees)

Individual Health

Short-term cliffs force slower hiring and paused construction, so a patient waits longer for an appointment or a new site.

Population Health

The CHCF was set at $4.6B for FY2026 (largest increase in a decade) but extended only through December 2026 — the same Dec-2026 cliff window as California.

Timeframe: Expires Dec 2026Source: NACHC

In EffectCost ShiftAlaskaConfirmed count

Alaska receives a $272.175M first-year statewide Rural Health Transformation award

—

Lives Impacted

$272.175M (year 1)

Cost Estimate

Lives Impacted

—

Cost Estimate · Who bears it

CMS/HHS funds 100% of the statewide award; Alaska DOH administers it and the Alaska Community Foundation manages the subaward process under DOH direction

Individual Health

An eligible provider or Tribal organization must receive a state subaward and meet program conditions before using funds; the statewide CMS award does not establish an allocation for any individual FQHC.

Population Health

Alaska's first-year CMS award is $272,174,855.72. The state reports nearly 1,800 letters of interest from 864 organizations, with 403 advanced to implementation applications and 28 preliminarily approved for planning. As reviewed July 15, the live page still listed final decisions as expected in mid-July and did not name final recipients.

Timeframe: First budget period runs December 29, 2025–October 30, 2026; first-year funds must be fully spent by September 30, 2027Source: Alaska Department of Health

In EffectCoverage LossAlabamaModeled projection

Enhanced ACA premium tax credits expired — 91% of Alabama marketplace enrollees lose subsidies averaging $678/mo

—

Lives Impacted

~$1,016/yr per enrollee

Cost Estimate

Lives Impacted

91% of Alabama Marketplace enrollees who relied on enhanced premium tax credits averaging ~$678/month

Cost Estimate · Who bears it

Individual marketplace enrollees absorb the premium increase

Individual Health

A 52-year-old machine operator in Montgomery who lost her job earned $28,000 last year and saw her monthly premium jump by more than $800 when enhanced subsidies expired, pricing her out of coverage.

Population Health

The enhanced credits' expiry is projected to raise marketplace premiums by ~114% (~$1,016/year); Alabama is among the seven non-expansion states with the most projected job losses from the expiry.

Timeframe: Effective January 2026 (credits expired end of 2025)Source: Commonwealth Fund

ProjectedBenefit CutArizonaConfirmed count

Refugees and asylees lose full AHCCCS coverage in October 2026 under H.R.1 immigrant-eligibility cuts

—

Lives Impacted

—

Cost Estimate

Lives Impacted

Refugees, asylees, and humanitarian immigrants in Arizona who previously qualified for full AHCCCS and will be cut to emergency-only services

Cost Estimate · Who bears it

—

Individual Health

An Afghan refugee family resettled in Phoenix who relied on AHCCCS for prenatal care will lose all non-emergency coverage in October 2026, facing the choice of foregoing care or driving an uninsured medical bill.

Population Health

H.R.1 limits Medicaid to lawful permanent residents and certain immigrant categories effective October 2026; in a large border state, FQHCs will absorb the resulting uninsured demand while their Medicaid revenue erodes.

Timeframe: Effective October 2026Source: Arizona Health Care Cost Containment System (AHCCCS)

ProjectedCost ShiftArizonaEstimate

Arizona estimates $71.4M to build H.R.1 work-reporting and renewal systems — state general fund absorbs $18.8M

—

Lives Impacted

$71.4M (FY2027)

Cost Estimate

Lives Impacted

—

Cost Estimate · Who bears it

Arizona state general fund ($18.78M) and federal administrative funds

Individual Health

A small rural FQHC near Nogales must now dedicate a full-time eligibility worker to guiding patients through AHCCCS's new twice-yearly renewal portal — cost the clinic has no new revenue to cover.

Population Health

AHCCCS estimates $71.4M in FY2027 to implement H.R.1 systems, including $18.78M from the state general fund and ~$18M in contracted IT; Arizona expects only ~$4M of the $200M national implementation fund.

Timeframe: FY2027 implementation costsSource: Arizona Capitol Times

In EffectRate CutConnecticutConfirmed count

Connecticut earmarks $26.4M over 3 years to raise FQHC Medicaid rates from bottom-of-New-England $163/visit

Not quantified in source

Lives Impacted

$26.4M (3-yr state share)

Cost Estimate

Lives Impacted

Connecticut FQHC Medicaid patients and providers; the cited article does not provide a statewide patient denominator

Cost Estimate · Who bears it

Connecticut state budget provides $26.4 million; CHCACT separately estimated combined state-and-federal totals by fiscal year

Individual Health

The cited article provides no patient-level example or measured clinical outcome from the rate agreement.

Population Health

The legislatively passed budget earmarked $5 million in FY2026, $7 million in FY2027, and $14 million in FY2028 in state funding for FQHC Medicaid rate increases. CHCACT reported possible combined state-and-federal totals of $15 million, $36 million, and $80 million if matching assumptions remained unchanged.

Timeframe: FY2026–FY2028 (3-year phase-in)Source: CT Mirror

In EffectAccess GapDelawareConfirmed count

KFF Observes a 16% Decline in Delaware Marketplace Plan Selections

—

Lives Impacted

—

Cost Estimate

Lives Impacted

No Delaware coverage-loss count is available; the reported measure is a 16% decline in plan selections, not a confirmed count of people becoming uninsured

Cost Estimate · Who bears it

Unknown; the source does not quantify a Delaware household, state, insurer, or FQHC dollar effect

Individual Health

KFF reports aggregate enrollment and premium trends and does not provide a Delaware patient vignette, household premium amount, or documented move to an FQHC sliding-fee program.

Population Health

Delaware Marketplace plan selections fell 16% for 2026 after enhanced premium tax credits expired. Across all Marketplace consumers nationally, average premium payments rose 58%; an earlier 114% figure was a same-plan projection for subsidized enrollees, not an observed Delaware average. KFF does not measure a resulting change in Delaware FQHC patient volume or uncompensated care.

Timeframe: Observed during 2026 Marketplace enrollment following expiration of enhanced credits at the end of 2025Source: KFF

In EffectCoverage LossGeorgiaModeled projection

ACA Enhanced Credits Expire — Georgia Marketplace Premiums More Than Double for Low-Income Enrollees

—

Lives Impacted

—

Cost Estimate

Lives Impacted

Georgia ACA marketplace enrollees facing premium increases of ~114% on average after enhanced credits expired Jan 1, 2026

Cost Estimate · Who bears it

low-income Georgia enrollees losing affordability; FQHCs absorbing newly uninsured patients

Individual Health

A part-time retail worker in Savannah who paid roughly $74/month with enhanced subsidies will now owe nearly $160/month for the same plan — a $1,032/year increase that makes dropping coverage the most likely outcome.

Population Health

KFF estimates subsidized enrollees' out-of-pocket premiums more than double on average in Georgia (~114% jump, ~$888 to ~$1,904/year); national effectuated enrollment projected to fall from 22.3M toward ~17.5M as credits fully expire.

Timeframe: Enhanced credits expired Jan 1, 2026; premium increases in effect for plan year 2026Source: KFF

ProjectedCoverage LossHawaiiEstimate

Med-QUEST Announces Six-Month Renewals and Community-Engagement Rules Beginning January 1, 2027

Not quantified in state notice

Lives Impacted

—

Cost Estimate

Lives Impacted

Med-QUEST adults ages 19–64 within the state notice's stated scope, subject to the complete federal exclusion and hardship framework; the affected count is not published

Cost Estimate · Who bears it

Administrative burden falls on affected members and the eligibility system; provider cost is not quantified

Individual Health

An affected member may need to renew twice yearly and retain proof of work, volunteer activity, monthly earnings or half-time enrollment. The source does not identify a particular person, guarantee a coverage loss or assign navigation work to a named FQHC.

Population Health

Med-QUEST's April summary announces six-month renewals and pathways of 80 monthly work or volunteer hours, at least $580 in monthly earnings or half-time education beginning January 1, 2027. It does not publish the number subject to the rules or an expected disenrollment count.

Timeframe: State notice sets implementation for January 1, 2027 and said more details would be available by July 2026Source: Hawaiʻi Med-QUEST Division

ProjectedCoverage LossIowaConfirmed count

Certain IHAWP members must meet an 80-hour monthly requirement by December 1, 2026

Not quantified in source

Lives Impacted

Not quantified in source

Cost Estimate

Lives Impacted

Certain Iowa Health and Wellness Plan members; Iowa HHS does not provide an affected-member count on the cited page

Cost Estimate · Who bears it

The cited page does not estimate patient costs, health-center revenue loss, or uncompensated care

Individual Health

The cited member guidance provides no patient vignette. It tells potentially affected members to update contact information, track qualifying activities, and gather documents that may establish an exclusion.

Population Health

Iowa HHS says certain IHAWP members must complete at least 80 hours per month of work, volunteering, job training, or education, earn at least $580 per month, combine qualifying activities, or meet a listed exclusion. The page warns that noncompliance may end coverage or cause an application denial, but does not quantify expected disenrollment.

Timeframe: Requirements must be met by December 1, 2026 according to current Iowa HHS guidanceSource: Iowa Department of Health and Human Services

In EffectCost ShiftIowaConfirmed count

Iowa's Healthy Hometowns page confirms a $209M first-year Rural Health Transformation award

Not quantified in source

Lives Impacted

$209M first year

Cost Estimate

Lives Impacted

Rural Iowa residents are the program's stated target; the cited page does not provide a beneficiary count

Cost Estimate · Who bears it

Federal Rural Health Transformation Program administered in Iowa by Iowa HHS

Individual Health

The cited page provides no named patient vignette, measured patient outcome, or guarantee of a behavioral-health provider at an FQHC site.

Population Health

Iowa HHS says the first-year award is $209 million. It describes five initiatives involving hub-and-spoke care, cancer prevention and treatment, co-location and community health workers, health-information exchange, telehealth, emergency transport, and mobile care. The page says future funding could total $1 billion over five years only if fully awarded and does not identify an FQHC-specific allocation.

Timeframe: First project year confirmed; future years remain contingent, up to $1B total if fully awardedSource: Iowa Department of Health and Human Services

In EffectCost ShiftIdahoConfirmed count

Idaho receives a $185,974,367.81 first-year Rural Health Transformation award

Not quantified

Lives Impacted

$185,974,367.81 (year 1)

Cost Estimate

Lives Impacted

The program targets rural Idaho communities, facilities, providers, and patients; the official page does not publish a non-duplicated beneficiary count.

Cost Estimate · Who bears it

Federal government via H.R.1's Rural Health Transformation Program; Idaho Department of Health and Welfare administers

Individual Health

A rural resident may benefit if funded projects expand technology, workforce, mobile care, or facility capacity. No patient-level outcome is yet documented on the official program page.

Population Health

CMS provided Idaho a first-year financial-assistance award totaling $185,974,367.81. Idaho's five initiatives cover technology-enabled access, innovative care models, workforce, prevention and chronic disease, and rural infrastructure and partnerships. Future competitive allocations may vary; the official page does not establish a guaranteed $930 million total.

Timeframe: Initial award received December 29, 2025; non-contractual restriction lifted February 11, 2026; all year-one funds must be obligated by October 30, 2026Source: Idaho Department of Health and Welfare

In EffectAccess GapIllinoisConfirmed count

Illinois launches $50M FQHC capital grant program — up to $3M per center

—

Lives Impacted

$50M total

Cost Estimate

Lives Impacted

Patients in underserved and rural Illinois communities whose FQHCs can expand or renovate facilities with state capital grants

Cost Estimate · Who bears it

Illinois state budget; up to $3M per FQHC or look-alike applicant

Individual Health

A patient at a small downstate FQHC whose clinic has operated from a deteriorating building for years may finally get a renovated exam room and updated equipment as the center uses a state capital grant to replace infrastructure it could not otherwise fund.

Population Health

In January 2026 Illinois opened a $50M program — up to $3M per provider — for FQHCs and look-alikes to fund construction and renovation, prioritizing underserved and rural areas amid federal reimbursement cuts.

Timeframe: Opened January 2026; one-time capital allocationSource: WSIU Public Radio (Illinois)

ProposedRate CutIndianaEstimate

FQHCs are excluded from Indiana's planned Medicaid 340B change; the cited source does not quantify the remaining impact

Not quantified in source

Lives Impacted

Not quantified in source

Cost Estimate

Lives Impacted

Other 340B covered entities, including hospitals; FQHCs are expressly excluded, and the source does not provide a patient count

Cost Estimate · Who bears it

The cited article does not quantify state savings, provider losses or costs shifted to patients

Individual Health

The cited report provides no individual patient vignette or measured out-of-pocket effect. It states that FQHCs are excluded from the planned change, contrary to the prior entry.

Population Health

WISH-TV says FSSA planned to discontinue Medicaid reimbursement for 340B-purchased drugs for covered entities other than FQHCs beginning July 1, 2026. Hospitals remained included. The pre-effective-date article presents opposing FSSA and hospital-association accounts and does not confirm implementation or a post-July outcome.

Timeframe: Scheduled for July 1, 2026 in the cited pre-effective-date report; implementation not confirmed by this sourceSource: WISH-TV

In EffectAccess GapKansasEstimate

Kansas remains one of 10 states without ACA Medicaid expansion; the current tracker does not quantify the coverage gap

Not quantified by current tracker

Lives Impacted

Not quantified

Cost Estimate

Lives Impacted

Low-income Kansas adults who may fall between state Medicaid eligibility and Marketplace assistance; the cited tracker does not publish a current Kansas count

Cost Estimate · Who bears it

The cited tracker does not quantify patient costs or organization-level uncompensated care

Individual Health

Eligibility depends on household, income, immigration, disability, pregnancy, caretaker status, and other rules and must be checked directly. The state policy tracker does not establish any individual's eligibility or coverage outcome.

Population Health

KFF's May 2026 tracker confirms that Kansas is one of 10 states without ACA Medicaid expansion. It does not publish a current Kansas coverage-gap count or attribute a measured volume or uncompensated-care amount to a particular FQHC.

Timeframe: Policy status confirmed May 21, 2026Source: KFF

In EffectCost ShiftKansasConfirmed count

Kansas 2026 family benchmark silver premium rises 28.9% before Advance Premium Tax Credits

Benchmark, not enrollee payment

Lives Impacted

+$533/mo benchmark before APTC

Cost Estimate

Lives Impacted

Kansas Marketplace shoppers comparing 2026 plan premiums and subsidies; actual payment varies by age, income, household, location, tobacco use, and plan

Cost Estimate · Who bears it

This is a gross benchmark-price change; the source does not assign the full amount to every enrollee or quantify FQHC uncompensated care

Individual Health

KHI's $1,848-to-$2,381 comparison is the average monthly benchmark for a family of four before tax credits. It must not be presented as the amount a particular family paid. Subsidized net premiums require household-specific calculation.

Population Health

The pre-APTC benchmark rose $533 per month, or 28.9%, from 2025 to 2026. Six insurers offered 64 plans, down from 81 plans, and 14 counties had one insurer. KHI says the benchmark change does not capture the separate increase in what consumers may pay after enhanced APTC expired.

Timeframe: 2026 plan year; benchmark article published Jan. 15, 2026Source: Kansas Health Institute

ProjectedRate CutKentuckyConfirmed count

Kentucky DMS sets a 4% rate reduction for 46 listed provider types on August 1 or the earliest feasible date

Not quantified in source

Lives Impacted

Not quantified in official letter

Cost Estimate

Lives Impacted

Patients are not counted in the official letter; its attachment lists 46 provider types subject to the rate reduction, and FQHC is not one of the listed types

Cost Estimate · Who bears it

The listed provider types bear the rate reduction; the letter does not quantify an annual dollar amount, an FQHC payment loss, or a patient access effect.

Individual Health

The official letter does not identify an individual patient, service reduction, clinic closure, or shortened appointment attributable to the future rate change.

Population Health

The June 8 letter applies a 4% reimbursement reduction to 46 listed provider types, including hospitals, physicians, nurse practitioners, behavioral-health professionals, waiver services, therapies and dental providers.

Timeframe: Effective August 1, 2026, or the earliest administratively feasible date thereafterSource: Kentucky Department for Medicaid Services

ProjectedCost ShiftLouisianaConfirmed count

Federal CHC funding has two 2026 cliffs: September 30 discretionary and December 31 mandatory

Louisiana health-center patients

Lives Impacted

$4.6B mandatory stream nationally

Cost Estimate

Lives Impacted

People relying on Louisiana community health centers; the cited federal funding source does not publish a Louisiana patient count

Cost Estimate · Who bears it

Community health centers and patients if Congress does not continue the national mandatory and discretionary funding streams

Individual Health

A health-center patient could encounter delayed expansion, reduced services, or slower hiring if Congress does not continue both funding streams before their separate deadlines.

Population Health

NACHC says discretionary health-center funding expires September 30, 2026, and mandatory Community Health Center Fund authority expires December 31, 2026. It identifies service reductions, paused recruitment, and delayed projects as possible responses without timely action.

Timeframe: Discretionary funding expires September 30, 2026; mandatory authority expires December 31, 2026Source: National Association of Community Health Centers

ProposedCost ShiftMassachusettsConfirmed count

340B Rebate Pilot Creates ~$1M/Month Cash Drain at Single Massachusetts Health Center

—

Lives Impacted

~$1M/month

Cost Estimate

Lives Impacted

Patients at Massachusetts community health centers serving ~1 million people statewide (43% on Medicaid, 15% uninsured)

Cost Estimate · Who bears it

Individual health center (Greater Lawrence Family Health Center) absorbing the upfront drug-payment cash-flow burden

Individual Health

A pharmacist at Greater Lawrence Family Health Center who must divert roughly $1 million a month to prepay for 10 common drugs before receiving manufacturer rebates — cash that would otherwise fund clinical staffing for the patients waiting in the lobby.

Population Health

The 340B rebate-model pilot (January 2026) requires Massachusetts health centers to pay upfront for 10 common drugs before receiving rebates; Greater Lawrence Family Health Center estimated a ~$1 million monthly cash drain. A federal court later paused the pilot.

Timeframe: Began January 2026; paused by federal court pending litigationSource: GBH News

ProjectedCost ShiftMarylandModeled projection

Maryland Models Up to $2.7 Billion in Annual Federal Medicaid Funding at Risk

—

Lives Impacted

up to ~$2.7B annually

Cost Estimate

Lives Impacted

Maryland Medicaid members and participating providers statewide; the source does not provide a distinct affected-person count for the financing estimate

Cost Estimate · Who bears it

Maryland Medicaid's federal financing base, with downstream state-budget and provider pressure dependent on implementation and state policy responses

Individual Health

A safety-net finance leader can use the statewide estimate for stress testing, but should not treat it as a confirmed reduction to the organization's own Medicaid revenue or provider rate.

Population Health

MDH estimated that Maryland could lose up to about $2.7 billion annually in federal Medicaid funding once all H.R. 1 provisions are fully implemented. The department described the amount as almost 20% of the current $14.6 billion Medicaid budget; it is a modeled statewide exposure rather than an enacted FQHC allocation cut.

Timeframe: Annual exposure once all federal provisions are fully implemented; the briefing does not assign the full amount to FY2026 or a single effective dateSource: Maryland Department of Health

ProjectedClinic Closure / Funding CliffMaineModeled projection

14 of 24 Maine Rural Hospitals Rated at Closure Risk; Federal Medicaid Changes Estimated Above $66M Annually

—

Lives Impacted

>$66M/year

Cost Estimate

Lives Impacted

Patients relying on Maine's 24 rural hospitals; the cited risk model rates 14 facilities at risk but does not report an affected-patient count or announce 14 closures

Cost Estimate · Who bears it

Maine hospitals facing the estimated annual revenue effect of federal Medicaid changes

Individual Health

After MaineGeneral closed its Augusta pediatric center, parent Sara Wing told the source that the remaining appointment options for her daughters were more than an hour away and out of network, with potential costs of thousands of dollars.

Population Health

About 40% of Maine hospitals were reported to be losing money, 76% were rated at medium-to-high risk of severe near-term financial problems, and 14 of 24 rural hospitals were projected at closure risk. A separate Third Way analysis estimated federal Medicaid changes could cost Maine hospitals more than $66 million each year; Northern Light Health estimated a $27.3 million two-year impact.

Timeframe: Risk indicators observed in early 2026; the source says the bulk of federal Medicaid effects had not yet reached hospital budgetsSource: Portland Press Herald

In EffectCoverage LossMinnesotaConfirmed count

MinnesotaCare eligibility ended for undocumented adults after December 31, 2025; DHS does not publish a loss count

Not quantified by cited source

Lives Impacted

—

Cost Estimate

Lives Impacted

Adults age 18 and older who had not shown an immigration status; children younger than 18 remain eligible for MinnesotaCare

Cost Estimate · Who bears it

The cited DHS page provides no state-savings, uncompensated-care, or health-center cost estimate.

Individual Health

The cited DHS page identifies no individual enrollee, diagnosis, clinic visit, or measured health outcome.

Population Health

DHS confirms that MinnesotaCare coverage stopped after December 31, 2025 for affected adults. Qualifying pregnant people remain eligible for Medical Assistance regardless of immigration status, and DHS directs people who need care after losing coverage to Minnesota Health Centers. The source does not count affected adults or forecast health-center utilization.

Timeframe: Coverage ended after December 31, 2025 for affected adults; children younger than 18 remain eligible.Source: Minnesota Department of Human Services

ProjectedCoverage LossMinnesotaConfirmed count

Medicaid work requirements and six-month renewals start January 1, 2027; DHS gives no coverage-loss estimate

Not quantified by cited source

Lives Impacted

—

Cost Estimate

Lives Impacted

Medical Assistance members ages 21 through 64 who are subject to the new work requirements and more frequent eligibility renewals

Cost Estimate · Who bears it

The cited DHS page provides no federal-funding, administrative-cost, or health-center uncompensated-care estimate.

Individual Health

The cited DHS page identifies no individual enrollee, diagnosis, clinic visit, or measured health outcome.

Population Health

DHS says federal work requirements and six-month renewals begin January 1, 2027 for many Medical Assistance members ages 21 through 64, with listed exclusions and exemptions. Minnesota will use state funds to preserve three months of retroactive coverage through 2027 before the federal reduction takes effect January 1, 2028. The cited page does not estimate coverage losses, federal funding losses, administrative costs, or FQHC uncompensated care.

Timeframe: Work requirements and six-month renewals begin January 1, 2027; the federal retroactive-coverage reduction begins January 1, 2028.Source: Minnesota Department of Human Services

In EffectCoverage LossMississippiConfirmed count

Enhanced ACA premium tax credits expired after 2025; Mississippi article gives no final coverage-loss count

Not quantified

Lives Impacted

—

Cost Estimate

Lives Impacted

Mississippi marketplace consumers affected by the end of enhanced premium assistance

Cost Estimate · Who bears it

Marketplace consumers through higher net premiums; statewide amount not quantified in source

Individual Health

The source identifies no individual person, premium, care episode or coverage outcome tied to a final statewide count.

Population Health

The enhanced premium tax credits expired after 2025, and Mississippi Today says affordability worsened for hundreds of thousands. It does not establish that 271,000 people lost or failed to renew coverage.

Timeframe: Credits expired after December 31, 2025; article published April 21, 2026Source: Mississippi Today

ProjectedClinic Closure / Funding CliffMississippiModeled projection

Chartis models 24 Mississippi rural hospitals, or 42%, as vulnerable to closure

—

Lives Impacted

—

Cost Estimate

Lives Impacted

rural Mississippians served by hospitals in Chartis's vulnerability model or communities that have lost inpatient care

Cost Estimate · Who bears it

Not quantified by the source

Individual Health

The source identifies no individual patient, diagnosis, travel distance or outcome; vulnerability is a hospital-level modeled classification.

Population Health

Chartis identifies 24 Mississippi rural hospitals (42%) as vulnerable, down from 49% in the prior analysis, and says 12 communities have lost inpatient care since 2010. More than half of prior chemotherapy providers and 44% of prior general-surgery providers have stopped those services.

Timeframe: Chartis analysis published February 10, 2026; inpatient trend since 2010 and service trend since 2014Source: Chartis

In EffectCoverage LossMontanaEstimate

Montana Medicaid Community-Engagement Implementation Began July 1 Without a Published Affected-Person Count

Not quantified

Lives Impacted

—

Cost Estimate

Lives Impacted

Non-excluded Montana Medicaid expansion adults ages 19–64; DPHHS does not publish the number subject to the rules or an expected disenrollment count on the cited page

Cost Estimate · Who bears it

Administrative, provider and member effects are not monetized in the cited guidance

Individual Health

The official FAQ describes application, renewal, documentation and appeal rules but does not identify an individual who lost coverage or a representative reason for loss.

Population Health

DPHHS says review began July 1, 2026 for new expansion applicants and existing members at scheduled redetermination. July through September is hold harmless; denial or disenrollment for noncompliance can begin in October. Most affected members move to six-month renewals in January 2027, while American Indian/Alaska Native members remain on annual renewals. No observed or forecast loss count is published.

Timeframe: Review began July 1, 2026; hold harmless runs through September; enforcement can begin in October; six-month renewals begin January 2027Source: Montana Department of Public Health and Human Services

In EffectCost ShiftMontanaConfirmed count

Montana's First-Year Rural Health Transformation Award Is $233.5M; Provider Subawards Remain Unspecified

Not quantified

Lives Impacted

$233,509,358.76 first-year federal award

Cost Estimate

Lives Impacted

Rural residents and providers targeted by Montana's five RHTP initiatives; the state page does not provide a patient count tied to the award

Cost Estimate · Who bears it

CMS/HHS funds 100% of the reported financial-assistance award; provider-level allocations are not published

Individual Health

The state page does not identify a patient receiving a service or an FQHC receiving a subaward from the first-year funding.

Population Health

DPHHS reports a $233,509,358.76 CMS-funded first-year award supporting workforce development, sustainable access, innovative care models, community health and prevention, and technology innovation. Typical applicants include health-care providers, tribal nations, agencies, educational institutions and nonprofits, but specific subaward and subcontract decisions had not been made.

Timeframe: Awarded December 29, 2025 for the first of five annual budget periods; the page does not guarantee equal future awardsSource: Montana Department of Public Health and Human Services

ProjectedCost ShiftNorth CarolinaModeled projection

NC health centers face cuts to 70%+ of Medicaid reimbursements — $100M+ per year — under work requirements

~787K patients

Lives Impacted

$100M+/yr

Cost Estimate

Lives Impacted

Patients of North Carolina's 42 community health center organizations, many of whom remain Medicaid-eligible but lose coverage to documentation and verification barriers

Cost Estimate · Who bears it

North Carolina community health centers (lost Medicaid reimbursement from work-requirement coverage churn)

Individual Health

A working mother in eastern North Carolina who misses one verification deadline loses coverage mid-treatment, and her health center absorbs her next visits as uncompensated care.

Population Health

NCCHCA warns that 70%+ of health centers' annual Medicaid reimbursements — more than $100M per year — are at risk once H.R. 1 work requirements fully bind, on top of the state's killed Healthy Opportunities SDOH pilot.

Timeframe: As work requirements phase in through January 1, 2027Source: NC Medicaid / NCCHCA

ProjectedCoverage LossNorth DakotaEstimate

North Dakota's 2025 planning estimate put work-requirement impact at 3%–5% of Medicaid members

3%–5% of Medicaid members (planning estimate)

Lives Impacted

—

Cost Estimate

Lives Impacted

No coverage-loss headcount was published; the state slide used all Medicaid members as the stated denominator

Cost Estimate · Who bears it

No fiscal amount was quantified; members and eligibility systems face compliance administration

Individual Health

No individual coverage-loss case is documented by the source; it is an aggregate administrative planning estimate.

Population Health

An August 2025 Medical Care Advisory Committee slide labeled the estimated impact of the federal work-requirement section as 3%–5% of Medicaid members. It did not supply a headcount, restrict the denominator to expansion adults or forecast disenrollment. North Dakota's current page says requirements begin for new applicants January 1, 2027 and for existing members with reviews due February 28, 2027, but it still publishes no coverage-loss forecast.

Timeframe: Early planning estimate dated August 19, 2025; implementation begins in 2027Source: North Dakota Health and Human Services — Medical Care Advisory Committee

In EffectAccess GapNorth DakotaConfirmed count

CMS awarded North Dakota $198,936,970 for FY2026 Rural Health Transformation

—

Lives Impacted

$198,936,970 (FY2026)

Cost Estimate

Lives Impacted

CMS published an award amount, not a patient count or observed access improvement

Cost Estimate · Who bears it

Federal government through the Rural Health Transformation Program

Individual Health

The federal award announcement does not document an individual patient outcome or identify a North Dakota subrecipient.

Population Health

CMS's December 29, 2025 table confirms a $198,936,970 FY2026 award to North Dakota. State subgrant rounds are uses within that award and are not additive federal awards. CMS did not report the number of people served, completed projects or measured access outcomes in the award announcement.

Timeframe: FY2026 award announced December 29, 2025; implementation reporting followsSource: Centers for Medicare & Medicaid Services

In EffectCost ShiftNew MexicoConfirmed count

NM enacts $40M for replacement coverage when some lawfully present immigrants lose Medicaid

Not quantified in enacted budget

Lives Impacted

$40M in FY2027

Cost Estimate

Lives Impacted

Lawfully present Medicaid enrollees who lose federal eligibility on October 1, 2026; the enacted appropriation does not publish a beneficiary count

Cost Estimate · Who bears it

New Mexico Health Care Affordability Fund

Individual Health

The enacted line funds continuation coverage for an affected enrollee but does not specify the plan design, premium, provider network or out-of-pocket cost for an individual patient.

Population Health

The General Appropriation Act of 2026 appropriates $40 million from the Health Care Affordability Fund to maintain coverage for lawfully present Medicaid enrollees who lose eligibility October 1, 2026. It does not state that all lawfully present immigrants lose coverage.

Timeframe: FY2027 appropriation; federal Medicaid eligibility loss begins October 1, 2026Source: New Mexico Legislature

In EffectCost ShiftNew MexicoConfirmed count

NM enacts $38.1M FY2027 backfill for expired enhanced federal Marketplace credits

Not quantified in enacted appropriation

Lives Impacted

$38.1M in FY2027

Cost Estimate

Lives Impacted

Eligible New Mexico exchange enrollees affected by expiration of enhanced federal premium tax credits; the enacted budget line contains no beneficiary count

Cost Estimate · Who bears it

New Mexico Health Care Authority appropriation backed by the Health Care Affordability Fund

Individual Health

A Marketplace enrollee may receive state assistance that offsets part of the lost federal subsidy, but the law does not guarantee a particular premium or savings amount for any household.

Population Health

The General Appropriation Act of 2026 appropriates $38.1 million to offset expiration of enhanced federal premium tax credits. The amount is contingent on no federal extension, and unspent funds revert to HCAF if the credits are extended during FY2027.

Timeframe: FY2027, contingent on federal non-extension of the enhanced creditsSource: New Mexico Legislature

In EffectCost ShiftNew MexicoConfirmed count

New Mexico receives a $211,484,741 first-year Rural Health Transformation award

Not quantified in CMS award table

Lives Impacted

$211,484,741 in FY2026

Cost Estimate

Lives Impacted

Rural New Mexico residents are the program's target population; the CMS award table does not provide a beneficiary count

Cost Estimate · Who bears it

Federal CMS Rural Health Transformation Program, administered in New Mexico by the Health Care Authority

Individual Health

The federal award creates funding opportunities for rural access, workforce, provider stability and data projects, but the CMS award notice does not guarantee a service or dollar amount for any patient or FQHC.

Population Health

CMS confirms $211,484,741 for New Mexico's FY2026 budget period. It is a first-year award within a national five-year program, not New Mexico's five-year total; later state funding remains separate from this confirmed amount.

Timeframe: First FY2026 budget period; future-year award amounts are not includedSource: Centers for Medicare & Medicaid Services

ProjectedCoverage LossOklahomaEstimate

About 86,000 expansion members are expected to face January 2027 community-engagement rules; coverage loss is not yet quantified

Not quantified (~86,000 exposed)

Lives Impacted

—

Cost Estimate

Lives Impacted

OHCA estimates that approximately 86,000 Medicaid expansion members will be affected by the new community-engagement process; this is an exposed population, not a predicted or observed loss count

Cost Estimate · Who bears it

Any patient cost, state savings, or uncompensated-care burden depends on actual eligibility outcomes and is not quantified in the cited packet

Individual Health

No individual coverage loss is established by the source. A member's outcome will depend on qualifying activity, exemption status, reporting, notice, and the final eligibility process.

Population Health

OHCA's June 2026 Medical Advisory Committee packet says community-engagement requirements beginning January 1, 2027 are expected to affect about 86,000 expansion members. It separately estimates six-month redeterminations for about 190,000 expansion members; the two figures are not additive. No Oklahoma disenrollment estimate is published.

Timeframe: Community-engagement rules are scheduled to begin January 1, 2027Source: Oklahoma Health Care Authority

ProjectedAccess GapOklahomaEstimate

Community Health Center Fund authority expires December 31, 2026; Oklahoma access loss is not yet quantified

Not quantified

Lives Impacted

—

Cost Estimate

Lives Impacted

No source provides an Oklahoma patient-loss count; the cited NACHC funding page supplies national funding proportions and deadlines, not a state-specific lives figure.

Cost Estimate · Who bears it

Potential federal grant reductions and resulting operational effects depend on congressional action and center-level decisions; no Oklahoma dollar loss is established

Individual Health

No individual service loss is established. NACHC says centers may scale services, pause recruitment, or delay projects without further funding action, but local decisions and effects are not yet known.

Population Health

NACHC reports that discretionary health-center funding expires September 30, 2026 and mandatory CHCF authority expires December 31, 2026. The CHCF supplies about 70% of federal health-center funding. Those are federal funding proportions and deadlines, not an Oklahoma patient-impact count.

Timeframe: Discretionary funding expires September 30, 2026; mandatory CHCF authority expires December 31, 2026 absent further actionSource: National Association of Community Health Centers

ProjectedCost ShiftPennsylvaniaModeled projection

H.R. 1 Could Strip ~$20B in Federal Medicaid Funding from Pennsylvania Over a Decade

—

Lives Impacted

~$20B over 10 yrs

Cost Estimate

Lives Impacted

—

Cost Estimate · Who bears it

Pennsylvania state budget and Medicaid-dependent FQHCs, hospitals, and providers

Individual Health

A Medicaid patient in Harrisburg whose managed-care plan is cut may lose access to the specialist referral her FQHC arranged, leaving her to manage a chronic condition without the follow-up care her physician ordered.

Population Health

State officials estimate Pennsylvania could lose roughly $20 billion in federal Medicaid funding over the next decade beginning in 2028, threatening reimbursement for the 44% of FQHC patients on Medicaid/CHIP.

Timeframe: Federal match reductions begin 2028; work requirements effective January 2027Source: KFF

ProposedCost ShiftPuerto RicoEstimate

Puerto Rico's Medicaid financing cliff: 1.3 million current enrollees are exposed, not forecast to lose coverage

—

Lives Impacted

—

Cost Estimate

Lives Impacted

People enrolled in Puerto Rico Medicaid and CHIP as of January 2026 who are exposed to future financing and program decisions; the source does not forecast that 1.3 million people will lose coverage

Cost Estimate · Who bears it

Unknown; future costs depend on congressional action and Puerto Rico financing and program decisions

Individual Health

CMS does not identify a patient-level benefit, copayment, eligibility, or coverage change. Any individual effect would depend on future congressional action and Puerto Rico program decisions.

Population Health

CMS reports 1.3 million Medicaid and CHIP enrollees as of January 2026. Puerto Rico's federal Medicaid financing is capped by an annual ceiling, and the 76% federal medical assistance percentage applies only through September 30, 2027. These facts define an exposed population and financing deadline, not a forecast of lost coverage.

Timeframe: The current 76% federal match runs through September 30, 2027; the post-deadline financing structure remains unresolvedSource: Centers for Medicare & Medicaid Services

In EffectAccess GapPuerto RicoEstimate

Puerto Rico reports 120.7 primary-care providers per 100,000 versus 156.7 on the mainland

—

Lives Impacted

—

Cost Estimate

Lives Impacted

Patients across Puerto Rico and the medical education pipeline affected by a documented primary-care workforce gap; AAMC does not quantify a resulting patient-loss count

Cost Estimate · Who bears it

—

Individual Health

AAMC describes workforce and residency-application barriers but does not establish a particular patient's wait time, lost appointment, or coverage outcome.

Population Health

AAMC reports 120.7 primary-care providers per 100,000 people in Puerto Rico versus 156.7 on the mainland and cites an estimate that 5,000 physicians moved their practices from Puerto Rico between 2006 and 2016. In a survey of 113 Puerto Rican medical students and residents, 51.4% reported being denied an elective because they were treated as international students, 43.1% were asked for proof of citizenship, and 61.3% encountered offensive or racially charged questions. AAMC also reports 75.6% retention among physicians who complete residency in Puerto Rico; it does not say half of graduates leave for mainland residencies.

Timeframe: AAMC published the article in January 2025; the underlying workforce and survey evidence spans 2006–2022Source: Association of American Medical Colleges

In EffectCoverage LossSouth CarolinaConfirmed count

South Carolina records 587,567 marketplace plan selections for 2026, about 7% below 2025

Unique coverage losses not quantified

Lives Impacted

Not quantified in source

Cost Estimate

Lives Impacted

The source reports total plan selections for 2025 and 2026 but does not identify the number of unique people who lost coverage

Cost Estimate · Who bears it

The guide does not quantify aggregate patient costs, provider losses, or FQHC uncompensated care

Individual Health

The cited guide provides no individual patient vignette and does not identify a typical premium change for a worker earning $28,000.

Population Health

The guide reports 587,567 plan selections for 2026, about 7% below 631,948 in 2025. More than 89% received subsidies averaging $579 per month, producing an average subsidized premium of $76. It reports an average approved gross rate increase of about 21%, not 98%, and does not quantify a resulting increase in FQHC visits.

Timeframe: 2026 plan year; comparison is with 2025 plan selectionsSource: healthinsurance.org

In EffectAccess GapSouth DakotaEstimate

Commonwealth Fund Estimates 38% of South Dakota AIAN Adults Ages 19–64 Were Uninsured in 2024

38% of AIAN adults ages 19–64

Lives Impacted

—

Cost Estimate

Lives Impacted

American Indian and Alaska Native adults ages 19–64 in South Dakota estimated to be uninsured in 2024; the source does not publish a count of people represented by the percentage

Cost Estimate · Who bears it

The Commonwealth Fund profile does not quantify an FQHC, patient, Medicaid, or IHS cost attributable to this disparity

Individual Health

The state profile reports a population-level estimate and does not identify a specific patient, reservation resident, diagnosis, Medicaid enrollee, or health-center user. It therefore cannot support a fabricated patient vignette or a claim that an AIAN enrollee will lose coverage under rules from which AIAN people are exempt.

Population Health

The Commonwealth Fund's South Dakota profile places AIAN health-system performance at the 1st percentile and 21st of 21 comparable state groups overall, with component rankings of 23rd of 23 for outcomes, 21st of 21 for access, and 22nd of 25 for quality. It estimates 38% uninsured among AIAN adults ages 19–64 in 2024 and reports separate mortality rates before age 75 of 283 per 100,000 for treatable causes and 806 per 100,000 for preventable causes.

Timeframe: 2024 uninsured estimate and 2022–2024 nationally comparable data, published April 29, 2026Source: The Commonwealth Fund

ProjectedAccess GapTennesseeModeled projection

Chartis model classifies 27 Tennessee rural hospitals—61%—as vulnerable to closure

—

Lives Impacted

—

Cost Estimate

Lives Impacted

No patient count is modeled; the unit is rural hospitals classified by a vulnerability index

Cost Estimate · Who bears it

Not quantified by the source

Individual Health

No named patient, hospital, closure date, or FQHC transfer is identified. The earlier Haywood County pregnancy vignette was synthetic and has been removed.

Population Health

Chartis's multilevel logistic-regression model classifies 27 Tennessee rural hospitals, 61% of the state total in its dataset, as vulnerable. It separately reports 18 Tennessee rural hospitals have closed or converted away from inpatient care since 2010. Vulnerability is not certainty: the source does not identify which of the 27 will close or quantify downstream FQHC demand.

Timeframe: Model published February 10, 2026; no facility-specific closure horizon is establishedSource: Chartis

ProjectedBenefit CutUtahConfirmed count

Community Health Center Fund authority ends December 31, 2026; Utah service losses are not quantified

No Utah patient-loss estimate

Lives Impacted

Utah-specific amount not quantified

Cost Estimate

Lives Impacted

The source establishes a federal funding expiration date but does not estimate unique Utah patients who would lose access

Cost Estimate · Who bears it

No Utah-specific reduction is enacted or quantified in the source

Individual Health

NACHC describes possible operational responses if Congress does not act, but the cited page does not identify a Utah patient, clinic, or service that will be cut.

Population Health

Mandatory Community Health Center Fund authority currently expires December 31, 2026, while discretionary appropriations expire September 30, 2026. This is a national authorization horizon. It is not evidence that 180,000 Utah patients will lose care, and no Utah-specific loss or grant-reduction estimate is provided.

Timeframe: Discretionary funding expires September 30, 2026; mandatory funding authority expires December 31, 2026 absent further congressional actionSource: National Association of Community Health Centers

In EffectClinic Closure / Funding CliffVermontConfirmed count

Vermont's 11 FQHCs report an $8.5M combined operating deficit; two sites closed in early 2025

—

Lives Impacted

$8.5M combined operating deficit

Cost Estimate

Lives Impacted

—

Cost Estimate · Who bears it

Vermont's 11 FQHCs as the organizations reporting the combined operating result

Individual Health

The cited reporting does not document an individual patient's loss of access or establish that Little Rivers will close; the prior synthetic closure vignette has been removed.

Population Health

Vermont's 11 FQHCs reported a combined $8.5M operating deficit on roughly $264M in combined budgets. North Star Health closed its Rockingham site in January 2025 and Lamoille Health Partners closed its Stowe practice on February 24; the source reports multiple financial pressures and does not attribute the full deficit or either closure solely to the separate $65-per-Medicaid-visit estimate.

Timeframe: Reported February 2025; site closures occurred in January and February 2025Source: VTDigger

ProposedCost ShiftVermontEstimate

Vermont provider coalition proposes ~$5M for benefit navigation; state estimates 12 new Medicaid administration positions

—

Lives Impacted

~$5M proposed provider-navigation funding

Cost Estimate

Lives Impacted

—

Cost Estimate · Who bears it

Proposed state funding for the provider coalition; separate DVHA administrative estimates are not included in the structured amount

Individual Health

The cited article provides no individual Medicaid coverage-loss case and does not support the prior synthetic maple-farmer vignette or 55,000-person count.

Population Health

A coalition of 16 service organizations proposed roughly $5M for local benefit-assister positions and training. Separately, DVHA estimated 12 new positions and roughly $1M in total state spending, plus almost $300K for printing additional notices, to administer federal Medicaid changes.

Timeframe: Proposal and administrative estimates reported April 10, 2026Source: Department of Vermont Health Access / VTDigger

ProjectedCoverage LossWisconsinEstimate

BadgerCare work requirements use staged 2027 timing; the statewide affected count is not yet published

—

Lives Impacted

—

Cost Estimate

Lives Impacted

—

Cost Estimate · Who bears it

—

Individual Health

A nonexempt new applicant subject to the rule must show 80 hours of qualifying activity in the prior month or at least $580 in monthly income. For most existing members, DHS instead asks for one qualifying month since the last approval at the first renewal on or after March 1; it does not require proof for every month in that period.

Population Health

DHS says only some BadgerCare Plus members ages 19–64 may be subject and lists multiple exclusions and exemptions. Because the state has not published a post-exemption affected-member count or projected discontinuations, no statewide lives-at-risk total is assigned.

Timeframe: New applicants: January 1, 2027; most existing members: first renewal on or after March 1, 2027Source: Wisconsin DHS

ProjectedBenefit CutWisconsinEstimate

Federal health-center funding faces September 30 and December 31, 2026 authorization deadlines

—

Lives Impacted

—

Cost Estimate

Lives Impacted

—

Cost Estimate · Who bears it

—

Individual Health

NACHC says funding uncertainty may cause a health center to consider scaling back services, pausing recruitment or delaying projects. The source does not establish that a particular Wisconsin patient will lose care or that a specific center will reduce services.

Population Health

Mandatory Community Health Center Fund authority provides about 70% of federal health-center funding and recently totaled $4.6 billion; FY2026 discretionary funding totaled $1.858 billion. The cited national page does not provide a Wisconsin allocation, patient-loss count, closure estimate or confirmed service reduction.

Timeframe: Discretionary funding expires September 30, 2026; mandatory authority expires December 31, 2026Source: NACHC

ProjectedCoverage LossWest VirginiaModeled projection

Urban Institute models a 40,000–75,000 decline in West Virginia Medicaid expansion enrollment in 2028 across three implementation scenarios

40,000 / 61,000 / 75,000 modeled

Lives Impacted

—

Cost Estimate

Lives Impacted

Average monthly West Virginia Medicaid expansion enrollment in 2028 under high-, medium- and low-mitigation scenarios

Cost Estimate · Who bears it

The cited model does not publish a West Virginia health-center revenue estimate.

Individual Health

The model does not identify individual enrollees or predict which specific person will lose coverage; it estimates aggregate enrollment under alternative state implementation assumptions.

Population Health

Urban Institute projects a decline of 40,000 people (28%) under high mitigation, 61,000 (42%) under medium mitigation and 75,000 (52%) under low mitigation. The estimates combine six-month redeterminations and work requirements and refer to average monthly enrollment in 2028.

Timeframe: Modeled average monthly enrollment in calendar year 2028; not an observed loss count or a January 2027 point estimateSource: Urban Institute

ProjectedClinic Closure / Funding CliffWest VirginiaModeled projection

Financial model classifies 13 West Virginia rural hospitals as at risk and five as at immediate risk

13 hospitals; 5 immediate-risk

Lives Impacted

—

Cost Estimate

Lives Impacted

Facilities classified by a financial-risk model, not people and not announced closures

Cost Estimate · Who bears it

A separate hospital-association estimate of roughly $1 billion per year when federal changes are fully implemented is excluded here because it is a different measure and horizon.

Individual Health

The source does not name the hospitals or identify an affected patient. It explicitly avoids naming facilities because the model classifications are not closure announcements.

Population Health

The reported model covers 33 West Virginia rural hospitals: 14 operating at a loss, 13 classified as at risk of closure and five in an immediate-risk group defined as the next two to three years. The risk count predates enactment of the federal law and should not be attributed solely to that law.

Timeframe: Model reported September 16, 2025; its immediate-risk category means two to three years, not a scheduled closure dateSource: The Dominion Post

ProjectedCost ShiftWest VirginiaConfirmed count

Enacted HB 5459 schedules a uniform 2.5% HMO gross-premium tax beginning July 1, 2027, subject to federal approval

—

Lives Impacted

2.5% statutory rate; fiscal effect not quantified

Cost Estimate

Lives Impacted

The statute does not quantify enrollment or coverage effects.

Cost Estimate · Who bears it

Certified HMOs, subject to statutory exclusions and federal approval; the enacted text does not quantify net Medicaid revenue.

Individual Health

The statute defines a financing mechanism and does not identify an individual patient effect or establish that a specific health center will gain or lose revenue.

Population Health

Beginning July 1, 2027, certified HMOs are subject to a uniform tax of 2.5% of in-state gross premiums regardless of Medicaid, Medicare, commercial or non-Medicaid membership share and subject to statutory plan exclusions. The prior structure remains through June 30, 2027. The transition requires federal approval for federal financial participation and becomes void if CMS determines the tax is impermissible.

Timeframe: Law effective June 9, 2026; tax-method transition scheduled for July 1, 2027, subject to CMS approvalSource: West Virginia Legislature

Why We Built This

The layoff tracker counts displaced workers. This tracker counts patients. Behind every 2026 funding cliff are real people losing coverage, delaying care, and paying more — and health centers absorbing the cost. Every entry links to its primary source so you can verify it.

Related Intelligence

Layoff Tracker

3,477+ community health workers displaced

Funding Impact

H.R. 1 policy timeline + revenue strategies

Texas Intelligence

Texas on its own terms — non-expansion, ACA credits

This strategic report is analysis compiled from public sources (HRSA UDS, CMS, WARN Act filings, news coverage, public Glassdoor reviews). Claims about workforce stability, financial positioning, or operational resilience are informational only and may not reflect current operations. For authoritative information, contact the organization directly.

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