Planning, streamlining and outreach will be critical for MassHealth to weather new Medicaid rules, says new Boston Indicators report

Collaboration ahead of new Medicaid work and eligibility requirements needed to automate and streamline systems and manage costs, protect benefits for Mass. residents

November 20, 2025

Boston – A new report from Boston Indicators, the research center at the Boston Foundation, and the Center for State Policy Analysis at Tufts University’s Jonathan M. Tisch College of Civic Life, finds that strategic decisions made between now and next January will play a determining role in how much federal Medicaid changes will affect enrollees in the state’s MassHealth insurance plan. The report, A Massachusetts Model for Medicaid Work Requirements, explores the potential impact of new Medicaid work and eligibility requirements on the program, and lays out strategies for a new model that helps minimize the number of Mass. residents losing coverage.

“The new Medicaid requirements aren’t a straight cut in benefits, but rather an effort to force people off Medicaid by complicating the work and documentation requirements for recipients,” said Lee Pelton, President and CEO of the Boston Foundation. “Ultimately, the Commonwealth has a shared interest in ensuring Massachusetts residents have the tools and supports to manage the complexity and obtain insurance for themselves and their families. This report lays out what we need to do now to get those tools and supports in place.”

The new rules, set to be implemented in January 2027 under the terms of the One Big Beautiful Bill Act, eliminate eligibility for thousands of legal immigrants in Massachusetts, mandate that non-exempted adults aged 19-64 work or volunteer for 80 hours per month, and expand reporting requirements to maintain benefits eligibility. While the scale of disruption is difficult to estimate, three analyses project that 100,000 to 350,000 Massachusetts residents could lose coverage.

Medicaid Report Cover Read the report from Boston Indicators

“While the specific regulations affecting MassHealth won’t be known until next spring, we know that this is more than a financial issue – it will require us to begin building systems that are more flexible and simple, and planning outreach that ensures MassHealth enrollees are as prepared as possible,” said Evan Horowitz, Director of the Center for State Policy Analysis. “Coordinated action will not only protect the state’s most vulnerable residents from losing coverage, it will also address the budgetary issues and shape a system far less haphazard and burdensome than one that relies heavily on emergency care.”

Using lessons learned from other states’ experiences with implementing more stringent Medicaid requirements, the report lays out four suggested steps:

  1. Use our discretion wisely.
  2. Automate everything we can—exemptions, work requirements, income checks.
  3. Make verifications and attestations as easy as possible.
  4. Build a statewide ground game to reach the most vulnerable.

Leveraging existing data and streamlining technology could relieve significant burdens on recipients and reduce loss of coverage, and considering adjacent legislative changes to, for example, improve data systems and provide more robust safety nets for those who do lose coverage will also be crucial.

“There’s no question this will be a challenge, but as a state with a track record as a leader and innovator in health insurance for our residents, Massachusetts is well-positioned to be a model for ways to minimize the impact of these Federal cuts,” said Kimberly Goulart, Senior Research Analyst at Boston Indicators and co-author of the report. “But the longer we delay in planning, the less likely we will be to take advantage of that leadership opportunity.”

The new report is available now at bostonindicators.org.