MedQuest administrators told the House Committee on Human Services on Nov. 7 that federal changes in HR1 will materially alter Medicaid eligibility and operations and will require substantial outreach, systems work and vendor support to implement.

Judy Moore Peterson, MedQuest administrator, told members "Medicaid is open, Medicaid is funded, and I want that that's some of the messaging we're trying to make sure people understand." She explained that MedQuest is a state-administered Medicaid program with federal matching funds and that about 388,430 people were enrolled after the pandemic-era enrollment increases.

Meredith (MedQuest staff) summarized enrollment history and demographics, describing the post-pandemic unwinding process and noting that the Affordable Care Act expansion population (about 127,000 members) is the group most affected by HR1 provisions. "So right now, it's once a year," she said of eligibility renewals, then explained that HR1 would require more frequent checks for the expansion population and other changes to eligibility verification.

Officials described three major categories of HR1 impacts that will take time and technical work to implement. First, immigrant eligibility will narrow beginning Oct. 1, 2026; MedQuest staff estimated 1,200 to 2,400 current enrollees could lose full Medicaid coverage and be limited to emergency-only benefits unless covered through state-funded alternatives. Second, retroactive coverage windows will shrink (expansion adults: 30 days; other groups: 60 days) for applications after 01/01/2027. Third, the bill requires work or community engagement for adults ages 1964 who are in the expansion group (80 hours per month of qualifying activities such as employment, education, or community service) and permits mandatory, limited copays (penny to $35, with several service exemptions).

MedQuest staff said some populations are exempt from the work requirement, including pregnant and postpartum people, former foster youth, adults who meet TANF or SNAP work rules, medically frail people, and parents of a dependent child age 13 or younger. Meredith noted the technical and operational challenges of verification and said MedQuest is preparing vendor assessments and outreach plans: "We're gathering all the info, assessing. They've got some sort of score sheets with criteria that they're using to assess the different models that are being presented to see what makes the most sense for our specific and unique needs and what will make it always with the eye. Our North Star is always what will make it the easiest for our people."

Officials described data sources they will pursue for automated verification (state wage records, education enrollment databases, claims data, health information exchange) and consent-based feeds for gig or self-employment income. They are also evaluating closed-loop referral platforms used for social needs to connect members with volunteer and work opportunities so hours can be documented without requiring each agency to build new case-management systems.

MedQuest staff estimated that, depending on churn and verification outcomes, about 16% to 32% (roughly 19,000 to 38,000) of the current expansion population could lose coverage if the work and renewal rules are applied and no additional exemptions or documentation supports are available. Officials emphasized that the state is assessing budget and staffing needs to update eligibility systems and perform the outreach required for a January 1, 2027 implementation timeline.

Pilots and approvals: Judy Moore Peterson said the state secured permission to implement several demonstrations and pilots, including continuous eligibility for young children, a new medical-respite benefit for people experiencing homelessness, and a pilot delivering healthy food boxes through FQHCs and health plans to help households facing SNAP interruptions. "We will be piloting with our community health centers and our health plans a, fruit...healthy fruit and vegetable and protein boxes," she said, describing a short-term pilot planned through mid-January.

Why it matters: Narrowed eligibility and new administrative requirements could increase uninsured rates and uncompensated care, strain hospitals and providers, and raise state costs if the state chooses to backfill federal funding gaps or pay for new systems and outreach. MedQuest officials said they will include budget requests for additional staff, systems and outreach in the governor's budget process.

What's next: MedQuest will continue vendor assessments, build outreach materials with community partners and refine a budget request for additional staff and IT work. Committee members asked MedQuest to coordinate cross-agency data sharing (for example, SNAP, public-housing and workforce records) to reduce duplicative documentation burdens and to consult community partners about practical verification and referral models.