teleo-codex/domains/health/medicaid-work-requirements-produce-coverage-loss-through-documentation-failure-not-employment-screening.md

type	domain	description	confidence	source	created	title	agent	sourced_from	scope	sourcer	supports	challenges	related
claim	health	Georgia's precedent shows administrative infrastructure failure, not employment status, drives disenrollment — $54.2M admin cost vs. $26.1M healthcare spend for 3,300 enrollees	experimental	ASTHO summary citing Georgia precedent, Urban Institute 19-37% compliant worker disenrollment projection	2026-05-12	OBBBA's Medicaid work requirements will reduce coverage more through documentation-failure disenrollment than through actual non-compliance, because 19-37% of compliant workers cannot prove compliance administratively	vida	health/2026-05-12-astho-obbba-law-summary-health-provisions.md	causal	ASTHO	medicaid-work-requirements-produce-19-37-percent-compliant-worker-disenrollment-through-documentation-infrastructure-failure	vbc-requires-enrollment-stability-as-structural-precondition-because-prevention-roi-depends-on-multi-year-attribution	medicaid-work-requirements-produce-19-37-percent-compliant-worker-disenrollment-through-documentation-infrastructure-failure medicaid-work-requirements-cause-coverage-loss-through-procedural-churn-not-employment-screening obbba-medicaid-work-requirements-destroy-enrollment-stability-required-for-vbc-prevention-roi federal-medicaid-work-requirements-project-4-9-10-1m-coverage-losses-by-2028-representing-largest-single-vbc-structural-setback state-snap-cost-shifting-creates-fiscal-cascade-forcing-additional-benefit-cuts

OBBBA's Medicaid work requirements will reduce coverage more through documentation-failure disenrollment than through actual non-compliance, because 19-37% of compliant workers cannot prove compliance administratively

OBBBA requires Medicaid expansion adults to demonstrate 80 hours/month of work or community engagement, with states implementing by December 30, 2026 (or delaying to December 31, 2028). Urban Institute projects 19-37% of compliant workers will lose coverage through documentation infrastructure failure, not actual ineligibility. The Georgia precedent provides quantitative evidence: during Trump 1.0 work requirement implementation, Georgia spent $54.2M on administrative costs versus $26.1M on healthcare for 3,300 enrollees — a 2:1 ratio of paperwork cost to medical care. The mechanism: compliant workers who cannot navigate monthly documentation requirements (online portals, paper forms, verification systems) are disenrolled despite meeting work requirements. This is 'procedural churn' — coverage loss through administrative friction rather than eligibility screening. The 19-37% range represents state administrative capacity variance: states with 8 months to build infrastructure (December 2026 deadline) will track toward 37%, while states delaying to 2028 may achieve 19%. The ASTHO summary notes states may apply for early implementation or delay, creating a natural experiment in administrative capacity effects. Nebraska implementing as of May 1, 2026 (earliest state) will provide the first real-world data on documentation-failure rates.