(The Center Square) – As new work requirements for Medicaid enrollees take effect in roughly 100 days, elected officials are ramping up efforts to inform residents of what changes they may soon face, including potentially losing coverage.
As a result of the One Big Beautiful Bill Act, the Illinois-administered federal program will soon be required to impose new work requirements of 80 hours per month, alongside other changes potentially making less people eligible for the federally funded health insurance program.
Cook County officials said in a news conference Wednesday that as people fall off the Medicaid rolls, the changes are also going to cost the county increasingly each year after they take effect.
Cook County Board President Toni Preckwinkle said the new changes are going to impact many residents in the largest Illinois county.
“One in five Americans, 20% of our population, relies on Medicaid for health coverage. The Congressional Budget Office estimates these changes will leave millions, millions of people uninsured,” Preckwinkle said.
She also said that the changes to the program won’t have the intended effect of saving the government from having to pay as much for the program, but rather it’ll shift the costs onto lower levels of government.
“These costs do not disappear. They're shifted to states, local governments, hospitals, and ultimately families. When people lose coverage unnecessarily, they're more likely to delay care, go without medications, and allow health conditions to worsen,” Preckwinkle said.
During the conference, Preckwinkle and other county commissioners explained that until new work requirements take effect, they seek to inform residents who will remain eligible, but are at risk of losing coverage due to a more complicated system.
Illinois Department of Health and Family Services Director Elizabeth Whitehorn said her department’s strategy as the Medicaid changes take effect include plans to assist residents that will remain eligible, ensure the program continues covering a vast variety of medical services, and “mitigate harm to customers and providers.”
She noted some other changes take effect sooner.
“We're just a week away from the first major HR1 eligibility change taking effect. On October 1st, approximately 9,300 Illinois Medicaid customers will lose coverage because HR1 removes Medicaid eligibility for certain lawfully present immigrants,” Whitehorn said.
Dr. Mehmet Oz, administrator of the Centers for Medicare and Medicaid Services, explained why he sees the work requirements as beneficial.
“Congress, very wisely said, ‘let’s get you back into the workforce. Let’s require you – to get free healthcare coverage – to be able to work 20 hours a week, or volunteer, or get an education. Just participate.’ If you can work, you should get up and work again,” Oz said at a White House press briefing in June.
In a recent ranking of every state’s Medicaid program implementation, Illinois was ranked 31st in the nation, mostly due to its expanded spending, previous lack of work requirements and expansion of the program from what congress originally created.
The state spent about $43.17 billion during the 2026 fiscal year that ended July 31. Spending was up $6.11 billion from FY 2024, according to state comptroller data.
For every dollar spent by the state on Medicaid, the federal government reimburses about 51.82%.
The program changes in work requirements do provide some exemptions, including for people with medical conditions preventing them from working, persons with disabilities, and those who already meet SNAP food assistance work requirements.
The changes to the program will take effect Jan. 1, and will be applicable to any new applications received after Dec. 31 at 5 p.m.
Current Affordable Care Act adult customers will have to verify they meet the work requirements once every six months, beginning in March to redetermine if enrollees are still eligible.
