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Montgomery County officials warn new Medicaid rules, October cutoff for some asylum seekers could widen uninsured gap
Summary
County health officials told the council that federal HR1 rules — including 80-hour monthly work requirements and six‑month redeterminations — plus an October cutoff for most asylees and refugees could increase local uninsured numbers; staff outlined outreach, a forthcoming symposium and safety‑net implications.
Montgomery County health officials told the County Council on June 30 that federal changes to Medicaid eligibility under HR1 will require recipients to document 80 hours of work per month and face eligibility redeterminations every six months, a shift county staff said will increase administrative workload and likely raise the number of uninsured residents.
“Now people are required to show 80 hours of work per month or they are at risk of losing their Medicaid benefits,” Dr. Keisha Davis said during the biannual Board of Health update, noting that the rule’s full effect is scheduled for Jan. 1, 2027. Officials added that an October 1 deadline will remove most asylees and refugees from Medicaid coverage, except for pregnant women and children.
Why it matters: County staff said Montgomery Cares and Care for Kids currently cover roughly 34,000 uninsured residents (about 45% of the local uninsured), but the county faces an estimated gap of about 40,000 people without coverage. Officials warned that Montgomery Cares’ current budget covers about 78,000 visits (an average of about 2.4 visits per enrolled person), and absorbing new patients will require difficult choices about budget, prioritization and access.
County response: Health department staff described planning underway: an internal Medicaid task force with community partners, an August 2026 Medicaid symposium to train nonprofit and clinic partners on state toolkits, and closer coordination with Montgomery Cares clinics and PCC to expand outreach and enrollment assistance. Dr. Davis said the state is building technical tools to ease verification but “we have not seen investments in the people to help the people,” warning the county will likely need more eligibility staff or other resources to avoid administrative losses of coverage.
Council questions and legal context: Council members asked whether the county can identify individuals who will lose coverage; staff said the state has resisted releasing immigration‑tied lists and urged strengthening clinics rather than relying on household lists for outreach. In response to a question about a recent state lawsuit challenging federal CMS guidance on medical‑frailty definitions, staff said states historically have sometimes succeeded when pushing back and emphasized that the county’s role will be to protect the local safety net while state and federal processes proceed.
What’s next: Officials recommended that the council consider budget and policy options to shore up safety‑net services — expanding clinic capacity, targeted outreach and possible staffing increases for eligibility processing — and said they will return with more detail and with public‑facing education through August symposiums and community partners.
