Maryland expanded Medicaid, so the federal work requirement that takes effect January 1, 2027 applies to its expansion adults. About 310,140 of them (8.3% of an expansion pool of 331,544) 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 83,399 people in Maryland lose coverage by 2034: 74,095 of them still eligible but lost to paperwork and reporting failures, and 9,304 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. Maryland scores 71 of 100 on this model's ex parte capability index, a low band; its eligibility system is MA EE.
Key figures
| Measure | Maryland |
|---|---|
| Expansion state | Yes |
| Subject to the requirement via waiver | No |
| Expansion pool (adults 19 to 64) | 331,544 |
| Adults subject, strict definition | 310,140 |
| Adults subject, permissive definition | 303,937 |
| Share of expansion pool subject | 8.3% |
| Projected coverage loss by 2034 | 83,399 |
| Hardship exception status | No qualifying counties |
| Early implementer | No |
| Ex parte capability score (0 to 100) | 71 (low) |
Who is subject in Maryland
Of the 310,140 subject adults, 31% already work 80 or more hours a month and 61% are not working. 20% have a child under 14 at home. Among those not working, 51% report a disability and 12% are caregivers.
| Characteristic | Share of subject adults |
|---|---|
| Age 19-24 | 16% |
| Age 25-34 | 19% |
| Age 35-44 | 16% |
| Age 45-54 | 18% |
| Age 55-64 | 31% |
| Not working | 61% |
| 1 to 19 hours a month | 1% |
| 20 to 79 hours a month | 7% |
| 80 or more hours a month (meets the bar) | 31% |
| Not working: Disabled | 51% |
| Not working: Caregiver | 12% |
| Not working: Postpartum | 0% |
| Not working: Student | 4% |
| Not working: Other | 33% |
Why eligible people lose coverage
Of the 83,399 projected to lose coverage in Maryland, 74,095 meet the requirement or qualify for an exemption but fail to document it. 37,267 of those are working people who cannot prove their hours through data the state can see, and 36,828 qualify for an exemption the state does not detect automatically.
| Group | Projected to lose coverage |
|---|---|
| Variable shifts / on-call work | 9,306 |
| Self-employed (other) | 8,846 |
| Multiple part-time jobs (aggregation failure) | 7,130 |
| Full-time students not auto-verified | 3,416 |
| Volunteering / job training | 2,745 |
| Cash-paid construction & trades | 2,233 |
| Seasonal: agriculture, hospitality, food service | 1,935 |
| Gig / courier (DoorDash, Uber, Lyft, Instacart) | 1,655 |
| Medically frail without auto-match | 15,902 |
| Caregivers of a disabled adult | 11,613 |
| American Indian / Alaska Native (tribal exemption) | 2,715 |
| SUD treatment not flagged in claims data | 2,210 |
| Kinship caregivers (non-parent) of children ≤13 | 2,205 |
| Other categorical exemptions (foster, AYA cancer, SNAP/TANF) | 801 |
| Parent caregivers of children ≤13 without auto-match | 745 |
| Recent incarceration (data-match gap) | 552 |
| Pregnancy / postpartum data lag | 86 |
Can the state renew people automatically?
The ex parte capability index blends the state's observed automatic-renewal rate (73% in CMS eligibility-processing data), the wage, disability, and other data sources it can query, and its history of churn. Maryland's composite score is 71 (low 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 | 71 |
| Observed ex parte | 73 |
| Core capability | 81 |
| Data sources | 76 |
| Historical churn | 50 |
How subjects overlap across exemption categories
| Combination | Adults | Share |
|---|---|---|
| None of the four | 140,759 | 45.4% |
| Working ≥ qualifying hours / income | 70,638 | 22.8% |
| Medically frail | 53,557 | 17.3% |
| Full-time student | 14,945 | 4.8% |
| Working ≥ qualifying hours / income + Parent caregiver of child ≤13 | 10,646 | 3.4% |
| Working ≥ qualifying hours / income + Full-time student | 10,159 | 3.3% |
| Working ≥ qualifying hours / income + Medically frail | 3,796 | 1.2% |
| Parent caregiver of child ≤13 | 3,289 | 1.1% |
Counties in Maryland
Subject adults concentrate: Montgomery County (53,727), Prince George's County (46,341), and Baltimore County (43,603) account for 46% of the state's subject population.
| County | Adults subject | Subject rate | Projected loss | Poverty rate | Working-age population |
|---|---|---|---|---|---|
| Montgomery County | 53,727 | 8.5% | 14,447 | 7.0% | 629,986 |
| Prince George's County | 46,341 | 7.8% | 12,461 | 10.0% | 591,044 |
| Baltimore County | 43,603 | 8.7% | 11,725 | 10.0% | 498,626 |
| Anne Arundel County | 29,144 | 8.0% | 7,837 | 6.0% | 362,788 |
| Baltimore city | 25,410 | 7.1% | 6,833 | 20.0% | 358,088 |
| Howard County | 16,852 | 8.4% | 4,532 | 5.0% | 201,276 |
| Frederick County | 14,260 | 8.3% | 3,835 | 6.0% | 172,602 |
| Harford County | 13,712 | 8.8% | 3,687 | 7.0% | 156,316 |
| Carroll County | 9,410 | 9.1% | 2,530 | 5.0% | 103,132 |
| Charles County | 8,152 | 7.8% | 2,192 | 6.0% | 104,520 |
| Washington County | 7,929 | 8.6% | 2,132 | 12.0% | 91,992 |
| Wicomico County | 5,848 | 9.5% | 1,573 | 14.0% | 61,653 |
| St. Mary's County | 5,745 | 8.2% | 1,545 | 8.0% | 69,928 |
| Cecil County | 5,570 | 8.9% | 1,498 | 10.0% | 62,582 |
| Calvert County | 5,006 | 8.9% | 1,346 | 4.0% | 56,096 |
| Allegany County | 3,710 | 9.2% | 998 | 16.0% | 40,162 |
| Worcester County | 3,246 | 11.3% | 873 | 8.0% | 28,646 |
| Queen Anne's County | 2,908 | 9.8% | 782 | 7.0% | 29,648 |
| Talbot County | 2,175 | 11.3% | 585 | 9.0% | 19,286 |
| Caroline County | 1,756 | 9.0% | 472 | 13.0% | 19,452 |
| Dorchester County | 1,746 | 9.7% | 470 | 15.0% | 17,979 |
| Garrett County | 1,615 | 9.9% | 434 | 11.0% | 16,309 |
| Kent County | 1,189 | 11.2% | 320 | 10.0% | 10,597 |
| Somerset County | 1,087 | 7.0% | 292 | 20.0% | 15,432 |
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.