Montgomery County warns tens of thousands could lose Medicaid coverage under federal HR 1 changes

County health officials warned Montgomery County Council members on Nov. 4 that sweeping federal changes in H.R. 1 could cause thousands of people to lose Medicaid coverage, increase emergency department use and reduce federal funding to local health providers.

The Department of Health and Human Services presented an estimate that roughly 23,500 county residents could lose Medicaid coverage between 2026 and 2028 because of increased paperwork and eligibility checks; an additional approximately 3,000 people could become categorically ineligible under proposed work-requirement rules, the department said. Dr. Nina Ashford, chief of public health services, said the county's Medicaid population is about 205,000 people and that roughly 44,000 of those are in the expansion population most affected by HR 1 provisions.

Why it matters: Medicaid funds are an economic and health-care backbone. Dr. Ashford told the council that Medicaid paid roughly 54% of revenues for Maryland community health centers in 2024 and that Montgomery…