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 County receives about $2.4 billion of Medicaid-related funding. Losses or administrative churn, she said, would reduce clinic revenues, push more patients into hospital emergency departments and increase costs across the system.

What officials told the council: Dr. James Bridgers, director of health and human services, described three parallel tracks the department is pursuing: public outreach and targeted enrollment assistance; coordination with hospitals, primary-care clinics and federally qualified health centers; and partnership-building with schools, libraries and nonprofit organizations for in-person navigation. He said the county has been planning for months and already is convening healthcare, nonprofit and philanthropic partners.

Sean Gibson, the county's health insurance manager, described operational impacts for a hypothetical 35-year-old barber whose coverage could be lost if an 80-hour monthly work documentation requirement is not met or if six-month renewals are missed. Gibson warned that the proposed change from a three-month retroactive eligibility period to a one-month period will leave people vulnerable if they are hospitalized and not enrolled promptly.

Other concerns: Laurie Garabe Aquino, chief for children, youth and family services, said refugees and some lawfully present immigrants face loss of eligibility for CHIP and other benefits; she outlined risks to child immunization and developmental screening if families lose coverage. Monica Martin, chief of behavioral health and crisis services, highlighted the effect on people with serious mental illness who may be unable to assemble required clinical documentation to claim an exemption.

County estimates and uncertainty: HHS presented a preliminary statewide estimate that HR 1 could reduce federal Medicaid funding by about 20% (roughly $2.7 billion) and potentially cause administrative losses affecting thousands locally. Officials stressed these are estimates; final impacts depend on Maryland's policy choices and federal guidance.

County plan and ask of the council: HHS asked the council to support funding for expanded outreach and staffing to prevent avoidable disenrollments; to join workgroups with hospitals, clinics, and nonprofits; and to back communication and translation efforts through schools, libraries and community partners so residents get timely help to keep or regain coverage.

What the county will do next: HHS said it will press the state for clear guidance, increase in-person navigation at libraries, rec centers and schools, coordinate with Nexus Montgomery (hospital coalition) and Montgomery Cares clinics, and seek philanthropic and state partners for targeted assistance. The department also offered to provide cost estimates for expanding primary-care capacity if a subset of people lose Medicaid.

Closing: Dr. Bridgers urged the council and the county's congressional delegation to press for protections and to work with the state to reduce administrative churn. "We will continue to plan, do, study and act," he said. "We don't have all the answers yet, but we will get there together."