teleo-codex/domains/health/obbba-medicaid-expansion-eliminates-coverage-universally-across-all-states.md

type	domain	description	confidence	source	created	title	agent	sourced_from	scope	sourcer	supports	challenges	related
claim	health	Urban Institute modeling shows every expansion state loses 18-68% of expansion enrollment depending on mitigation scenario, demonstrating federal mandate overrides state implementation capacity	experimental	Urban Institute state-level enrollment projections, 2025	2026-05-12	OBBBA Medicaid work requirements eliminate expansion coverage universally with no state-level protection pathway	vida	health/2026-05-12-urban-institute-medicaid-expansion-enrollment-reductions.md	structural	Urban Institute	federal-medicaid-work-requirements-project-4-9-10-1m-coverage-losses-by-2028-representing-largest-single-vbc-structural-setback	state-medicaid-exemption-infrastructure-capacity-determines-work-requirement-mortality-with-90-percent-versus-30-percent-death-aversion	federal-medicaid-work-requirements-project-4-9-10-1m-coverage-losses-by-2028-representing-largest-single-vbc-structural-setback obbba-medicaid-work-requirements-destroy-enrollment-stability-required-for-vbc-prevention-roi double-coverage-compression-simultaneous-medicaid-cuts-and-aptc-expiry-eliminate-coverage-for-under-400-fpl

OBBBA Medicaid work requirements eliminate expansion coverage universally with no state-level protection pathway

Urban Institute's state-level modeling projects that expansion enrollment will fall by 37-68% in low mitigation scenarios, 30-54% in medium mitigation, and 18-33% in high mitigation scenarios. Critically, every expansion state loses coverage—there is no 'absorption' state that successfully protects its population through superior implementation. This challenges the assumption that blue states with strong Medicaid infrastructure can mitigate federal work requirements through administrative competence. The 18% floor in the best-case scenario represents structural coverage loss that no state can prevent. The range (18-68%) reflects state administrative capacity differences, but the universal coverage loss demonstrates that the federal mandate creates binding constraints that state-level policy cannot overcome. This is distinct from previous Medicaid policy changes where state variation produced winners and losers—OBBBA creates only losers with varying magnitudes of loss.