Gizmo Warehouseby Joe Eichenbaum | 17A

Medicaid work requirements · Illinois

Medicaid work requirements in Illinois: who is subject and who loses coverage (2027)

Data snapshot 2026-06-03 · part of These 5 Million People Are About to Lose Their Medicaid — But They Don't Have To

Illinois expanded Medicaid, so the federal work requirement that takes effect January 1, 2027 applies to its expansion adults. About 761,540 of them (10.0% of an expansion pool of 814,097) 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 211,377 people in Illinois lose coverage by 2034: 188,530 of them still eligible but lost to paperwork and reporting failures, and 22,846 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. Illinois scores 72 of 100 on this model's ex parte capability index, a low band; its eligibility system is IES.

Key figures

Model v2-2026-06-03. "Strict" counts adults whose ACS record shows them subject with no observable exemption; "permissive" allows the broader exemption reading.
MeasureIllinois
Expansion stateYes
Subject to the requirement via waiverNo
Expansion pool (adults 19 to 64)814,097
Adults subject, strict definition761,540
Adults subject, permissive definition746,310
Share of expansion pool subject10.0%
Projected coverage loss by 2034211,377
Hardship exception statusAdopting
Early implementerNo
Ex parte capability score (0 to 100)72 (low)

Who is subject in Illinois

Of the 761,540 subject adults, 39% already work 80 or more hours a month and 53% are not working. 36% have a child under 14 at home. Among those not working, 45% report a disability and 19% are caregivers.

ACS PUMS 5-year 2020 to 2024, subject adults only.
CharacteristicShare of subject adults
Age 19-2415%
Age 25-3422%
Age 35-4421%
Age 45-5418%
Age 55-6424%
Not working53%
1 to 19 hours a month1%
20 to 79 hours a month7%
80 or more hours a month (meets the bar)39%
Not working: Disabled45%
Not working: Caregiver19%
Not working: Postpartum0%
Not working: Student3%
Not working: Other33%

Why eligible people lose coverage

Of the 211,377 projected to lose coverage in Illinois, 188,530 meet the requirement or qualify for an exemption but fail to document it. 98,226 of those are working people who cannot prove their hours through data the state can see, and 90,304 qualify for an exemption the state does not detect automatically.

Bottom-up model v8.0-2026-05-30; documentation-failure buckets compound over the 14 six-month renewal cycles through 2034.
GroupProjected to lose coverage
Variable shifts / on-call work25,849
Multiple part-time jobs (aggregation failure)22,644
Self-employed (other)19,014
Full-time students not auto-verified8,388
Volunteering / job training6,741
Cash-paid construction & trades5,709
Gig / courier (DoorDash, Uber, Lyft, Instacart)5,245
Seasonal: agriculture, hospitality, food service4,637
Medically frail without auto-match34,076
Caregivers of a disabled adult23,334
Parent caregivers of children ≤13 without auto-match9,024
American Indian / Alaska Native (tribal exemption)8,791
SUD treatment not flagged in claims data6,321
Kinship caregivers (non-parent) of children ≤134,427
Recent incarceration (data-match gap)1,976
Other categorical exemptions (foster, AYA cancer, SNAP/TANF)1,966
Pregnancy / postpartum data lag389

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. Illinois's composite score is 72 (low band). A low score means more eligible people will be dropped for paperwork unless the state changes its process before January 1, 2027.

ComponentScore
Composite72
Observed ex parte79
Core capability85
Data sources72
Historical churn50

How subjects overlap across exemption categories

Each subject adult sits in exactly one cell. Categories: Working ≥ qualifying hours / income; Parent caregiver of child ≤13; Medically frail; Full-time student.
CombinationAdultsShare
None of the four272,39635.8%
Working ≥ qualifying hours / income141,53018.6%
Working ≥ qualifying hours / income + Parent caregiver of child ≤13111,30214.6%
Medically frail104,96713.8%
Parent caregiver of child ≤1348,1246.3%
Full-time student28,0273.7%
Working ≥ qualifying hours / income + Full-time student18,7032.5%
Working ≥ qualifying hours / income + Parent caregiver of child ≤13 + Full-time student10,5331.4%

Counties in Illinois

Subject adults concentrate: Cook County (291,453), DuPage County (57,040), and Lake County (43,853) account for 52% of the state's subject population.

All 102 counties in Illinois with subject adults, sorted by count. County figures are model allocations of the state estimate by ACS tract characteristics.
CountyAdults subjectSubject rateProjected lossPoverty rateWorking-age population
Cook County291,4539.1%80,89713.0%3,201,018
DuPage County57,04010.3%15,8326.0%551,632
Lake County43,85310.3%12,1728.0%423,979
Will County42,46110.0%11,7867.0%424,364
Kane County31,95610.4%8,8708.0%306,477
McHenry County19,65310.5%5,4556.0%186,242
Winnebago County17,36210.8%4,81916.0%161,008
Madison County16,03910.3%4,45212.0%155,174
Champaign County15,92212.0%4,41919.0%132,810
St. Clair County14,84710.0%4,12114.0%148,230
Sangamon County11,88910.6%3,30013.0%112,282
McLean County11,61511.0%3,22414.0%105,962
Peoria County10,73610.6%2,98015.0%101,491
Rock Island County9,00611.3%2,50015.0%79,709
Tazewell County7,90210.6%2,1939.0%74,453
Kendall County7,7819.4%2,1605.0%83,098
DeKalb County7,12311.4%1,97715.0%62,434
LaSalle County6,89711.0%1,91414.0%62,853
Kankakee County6,68110.8%1,85514.0%61,744
Macon County6,35611.3%1,76415.0%56,162
Vermilion County4,41811.1%1,22617.0%39,964
Jackson County4,16912.7%1,15723.0%32,924
Adams County4,05411.2%1,12512.0%36,080
Williamson County3,90310.0%1,08313.0%38,926
Whiteside County3,63012.0%1,00812.0%30,362
Boone County3,41111.0%94710.0%30,912
Grundy County3,34910.6%9306.0%31,662
Ogle County3,29211.3%9148.0%29,178
Knox County3,24411.8%90016.0%27,478
Coles County3,22011.3%89419.0%28,511
Henry County3,15511.7%8769.0%27,061
Stephenson County2,87112.3%79713.0%23,378
Macoupin County2,85411.3%79215.0%25,153
Woodford County2,48811.7%6917.0%21,247
Franklin County2,28510.9%63418.0%20,906
Marion County2,25511.0%62617.0%20,462
Monroe County2,24511.1%6234.0%20,150
Clinton County2,22010.2%6167.0%21,674
Morgan County2,20811.5%61313.0%19,218
Bureau County2,20612.2%61213.0%18,094
Livingston County2,18710.8%60710.0%20,222
Jefferson County2,18010.5%60514.0%20,728
Effingham County2,11210.9%58611.0%19,416
McDonough County2,06812.9%57420.0%16,038
Christian County2,04510.3%56812.0%19,954
Fulton County2,02410.5%56213.0%19,180
Lee County1,96510.0%54512.0%19,693
Randolph County1,82610.5%50713.0%17,326
Iroquois County1,77112.2%49211.0%14,502
Logan County1,71710.3%47712.0%16,640
Montgomery County1,68310.5%46714.0%16,048
Jo Daviess County1,61714.5%4498.0%11,160
Jersey County1,40811.3%3918.0%12,405
Shelby County1,39512.4%38710.0%11,218
Saline County1,36010.3%37818.0%13,226
Fayette County1,32610.6%36815.0%12,516
Douglas County1,24311.3%3459.0%10,982
Perry County1,1989.8%33217.0%12,181
Hancock County1,17612.7%32713.0%9,233
Warren County1,17412.8%32615.0%9,141
Bond County1,13111.1%31415.0%10,163
Crawford County1,09810.0%30510.0%10,940
Mercer County1,08012.4%3008.0%8,700
Carroll County1,06411.9%29511.0%8,922
Wayne County1,04912.1%29114.0%8,692
Piatt County1,04811.1%2917.0%9,408
Union County1,03811.2%28820.0%9,284
Edgar County1,01211.2%28112.0%9,030
De Witt County99611.3%27610.0%8,790
Clark County99011.5%2759.0%8,616
Richland County94210.9%26214.0%8,624
Moultrie County91611.6%2549.0%7,918
Pike County90011.5%25013.0%7,824
Washington County89611.7%2498.0%7,678
Johnson County87110.8%24216.0%8,103
Lawrence County8479.1%23514.0%9,306
Massac County82710.7%23014.0%7,736
Mason County82511.7%22914.0%7,033
Ford County81210.8%22512.0%7,516
Clay County80211.4%22316.0%7,062
Cass County80011.1%22212.0%7,231
White County79210.8%22015.0%7,353
Menard County78411.4%2188.0%6,848
Marshall County75611.9%21012.0%6,372
Greene County73911.3%20514.0%6,571
Wabash County73411.9%20413.0%6,150
Cumberland County67211.7%18710.0%5,750
Jasper County61512.1%1719.0%5,068
Hamilton County51211.9%14213.0%4,312
Schuyler County46912.2%13020.0%3,840
Henderson County42112.8%1179.0%3,286
Putnam County41813.6%1169.0%3,070
Edwards County39011.8%10814.0%3,300
Stark County35412.2%9812.0%2,900
Pulaski County35213.0%9825.0%2,716
Calhoun County32914.2%918.0%2,324
Scott County32812.2%9111.0%2,704
Alexander County32012.5%8921.0%2,549
Gallatin County31112.0%8619.0%2,578
Brown County2686.4%7410.0%4,214
Pope County26412.7%7319.0%2,081
Hardin County24512.4%6812.0%1,974

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.

Sources

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