Hawaii expanded Medicaid, so the federal work requirement that takes effect January 1, 2027 applies to its expansion adults. About 122,248 of them (14.6% of an expansion pool of 130,685) will have to prove 80 hours a month of work, school, or service, or an exemption, to keep coverage.
This model's bottom-up estimate is that 29,771 people in Hawaii lose coverage by 2034: 26,103 of them still eligible but lost to paperwork and reporting failures, and 3,667 not meeting the requirement. Nationally the same model gives 5,461,400, against CBO's 5,200,000.
Whether those eligible people keep coverage depends on the state's ability to renew them automatically (ex parte) from data it already holds. Hawaii scores 68 of 100 on this model's ex parte capability index, a mid band; its eligibility system is KOLEA.
Key figures
| Measure | Hawaii |
|---|---|
| Expansion state | Yes |
| Subject to the requirement via waiver | No |
| Expansion pool (adults 19 to 64) | 130,685 |
| Adults subject, strict definition | 122,248 |
| Adults subject, permissive definition | 119,803 |
| Share of expansion pool subject | 14.6% |
| Projected coverage loss by 2034 | 29,771 |
| Hardship exception status | Undecided |
| Early implementer | No |
| Ex parte capability score (0 to 100) | 68 (mid) |
Who is subject in Hawaii
Of the 122,248 subject adults, 28% already work 80 or more hours a month and 61% are not working. 26% have a child under 14 at home. Among those not working, 42% report a disability and 18% are caregivers.
| Characteristic | Share of subject adults |
|---|---|
| Age 19-24 | 13% |
| Age 25-34 | 22% |
| Age 35-44 | 18% |
| Age 45-54 | 19% |
| Age 55-64 | 28% |
| Not working | 61% |
| 1 to 19 hours a month | 1% |
| 20 to 79 hours a month | 9% |
| 80 or more hours a month (meets the bar) | 28% |
| Not working: Disabled | 42% |
| Not working: Caregiver | 18% |
| Not working: Postpartum | 1% |
| Not working: Student | 3% |
| Not working: Other | 36% |
Why eligible people lose coverage
Of the 29,771 projected to lose coverage in Hawaii, 26,103 meet the requirement or qualify for an exemption but fail to document it. 11,456 of those are working people who cannot prove their hours through data the state can see, and 14,648 qualify for an exemption the state does not detect automatically.
| Group | Projected to lose coverage |
|---|---|
| Multiple part-time jobs (aggregation failure) | 3,150 |
| Self-employed (other) | 2,660 |
| Variable shifts / on-call work | 2,080 |
| Full-time students not auto-verified | 1,277 |
| Cash-paid construction & trades | 667 |
| Volunteering / job training | 595 |
| Gig / courier (DoorDash, Uber, Lyft, Instacart) | 552 |
| Seasonal: agriculture, hospitality, food service | 473 |
| Medically frail without auto-match | 5,457 |
| Caregivers of a disabled adult | 3,380 |
| Kinship caregivers (non-parent) of children ≤13 | 1,361 |
| Parent caregivers of children ≤13 without auto-match | 1,231 |
| American Indian / Alaska Native (tribal exemption) | 1,134 |
| Other categorical exemptions (foster, AYA cancer, SNAP/TANF) | 842 |
| SUD treatment not flagged in claims data | 790 |
| Recent incarceration (data-match gap) | 403 |
| Pregnancy / postpartum data lag | 50 |
Can the state renew people automatically?
The ex parte capability index blends the state's observed automatic-renewal rate (79% in CMS eligibility-processing data), the wage, disability, and other data sources it can query, and its history of churn. Hawaii's composite score is 68 (mid band). A low score means more eligible people will be dropped for paperwork unless the state changes its process before January 1, 2027.
| Component | Score |
|---|---|
| Composite | 68 |
| Observed ex parte | 79 |
| Core capability | 82 |
| Data sources | 60 |
| Historical churn | 50 |
How subjects overlap across exemption categories
| Combination | Adults | Share |
|---|---|---|
| None of the four | 59,878 | 49.0% |
| Working ≥ qualifying hours / income | 26,337 | 21.5% |
| Medically frail | 18,139 | 14.8% |
| Full-time student | 6,049 | 5.0% |
| Working ≥ qualifying hours / income + Parent caregiver of child ≤13 | 5,287 | 4.3% |
| Parent caregiver of child ≤13 | 2,155 | 1.8% |
| Working ≥ qualifying hours / income + Full-time student | 2,083 | 1.7% |
| Working ≥ qualifying hours / income + Medically frail | 1,049 | 0.9% |
State brief and methodology
Estimates, not counts. The model rakes to CBO's national subject total and allocates by ACS microdata; state agencies hold the administrative data that would replace these figures.