Massachusetts expanded Medicaid, so the federal work requirement that takes effect January 1, 2027 applies to its expansion adults. About 321,878 of them (7.5% of an expansion pool of 344,092) 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 72,142 people in Massachusetts lose coverage by 2034: 62,486 of them still eligible but lost to paperwork and reporting failures, and 9,656 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. Massachusetts scores 72 of 100 on this model's ex parte capability index, a low band; its eligibility system is HIX-IES.
Key figures
| Measure | Massachusetts |
|---|---|
| Expansion state | Yes |
| Subject to the requirement via waiver | No |
| Expansion pool (adults 19 to 64) | 344,092 |
| Adults subject, strict definition | 321,878 |
| Adults subject, permissive definition | 315,440 |
| Share of expansion pool subject | 7.5% |
| Projected coverage loss by 2034 | 72,142 |
| Hardship exception status | No qualifying counties |
| Early implementer | No |
| Ex parte capability score (0 to 100) | 72 (low) |
Who is subject in Massachusetts
Of the 321,878 subject adults, 24% already work 80 or more hours a month and 66% are not working. 13% have a child under 14 at home. Among those not working, 54% report a disability and 7% are caregivers.
| Characteristic | Share of subject adults |
|---|---|
| Age 19-24 | 14% |
| Age 25-34 | 17% |
| Age 35-44 | 13% |
| Age 45-54 | 20% |
| Age 55-64 | 35% |
| Not working | 66% |
| 1 to 19 hours a month | 1% |
| 20 to 79 hours a month | 9% |
| 80 or more hours a month (meets the bar) | 24% |
| Not working: Disabled | 54% |
| Not working: Caregiver | 7% |
| Not working: Postpartum | 0% |
| Not working: Student | 4% |
| Not working: Other | 35% |
Why eligible people lose coverage
Of the 72,142 projected to lose coverage in Massachusetts, 62,486 meet the requirement or qualify for an exemption but fail to document it. 23,162 of those are working people who cannot prove their hours through data the state can see, and 39,324 qualify for an exemption the state does not detect automatically.
| Group | Projected to lose coverage |
|---|---|
| Multiple part-time jobs (aggregation failure) | 7,242 |
| Variable shifts / on-call work | 5,075 |
| Self-employed (other) | 3,646 |
| Full-time students not auto-verified | 2,533 |
| Seasonal: agriculture, hospitality, food service | 1,542 |
| Volunteering / job training | 1,187 |
| Cash-paid construction & trades | 1,072 |
| Gig / courier (DoorDash, Uber, Lyft, Instacart) | 866 |
| Medically frail without auto-match | 20,637 |
| Caregivers of a disabled adult | 11,039 |
| SUD treatment not flagged in claims data | 2,885 |
| Kinship caregivers (non-parent) of children ≤13 | 1,905 |
| American Indian / Alaska Native (tribal exemption) | 1,361 |
| Other categorical exemptions (foster, AYA cancer, SNAP/TANF) | 831 |
| Parent caregivers of children ≤13 without auto-match | 317 |
| Recent incarceration (data-match gap) | 279 |
| Pregnancy / postpartum data lag | 71 |
Can the state renew people automatically?
The ex parte capability index blends the state's observed automatic-renewal rate (72% in CMS eligibility-processing data), the wage, disability, and other data sources it can query, and its history of churn. Massachusetts'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.
| Component | Score |
|---|---|
| Composite | 72 |
| Observed ex parte | 72 |
| Core capability | 96 |
| Data sources | 80 |
| Historical churn | 50 |
How subjects overlap across exemption categories
| Combination | Adults | Share |
|---|---|---|
| None of the four | 156,081 | 48.5% |
| Medically frail | 70,742 | 22.0% |
| Working ≥ qualifying hours / income | 61,874 | 19.2% |
| Full-time student | 16,306 | 5.1% |
| Working ≥ qualifying hours / income + Full-time student | 10,727 | 3.3% |
| Working ≥ qualifying hours / income + Medically frail | 3,890 | 1.2% |
| Medically frail + Full-time student | 1,370 | 0.4% |
| Working ≥ qualifying hours / income + Parent caregiver of child ≤13 | 396 | 0.1% |
Counties in Massachusetts
Subject adults concentrate: Middlesex County (72,982), Worcester County (39,736), and Essex County (37,331) account for 47% of the state's subject population.
| County | Adults subject | Subject rate | Projected loss | Poverty rate | Working-age population |
|---|---|---|---|---|---|
| Middlesex County | 72,982 | 7.1% | 16,357 | 7.0% | 1,029,014 |
| Worcester County | 39,736 | 7.5% | 8,906 | 10.0% | 529,098 |
| Essex County | 37,331 | 7.7% | 8,367 | 10.0% | 483,060 |
| Norfolk County | 32,600 | 7.4% | 7,306 | 6.0% | 442,168 |
| Suffolk County | 32,598 | 6.1% | 7,306 | 17.0% | 537,613 |
| Bristol County | 26,168 | 7.4% | 5,865 | 11.0% | 352,194 |
| Plymouth County | 25,004 | 8.0% | 5,604 | 7.0% | 312,426 |
| Hampden County | 21,372 | 7.8% | 4,790 | 16.0% | 274,800 |
| Barnstable County | 12,974 | 10.8% | 2,908 | 7.0% | 120,194 |
| Hampshire County | 9,227 | 9.2% | 2,068 | 11.0% | 100,311 |
| Berkshire County | 6,683 | 9.0% | 1,498 | 11.0% | 74,216 |
| Franklin County | 3,542 | 8.6% | 794 | 12.0% | 41,078 |
| Dukes County | 938 | 8.0% | 210 | 7.0% | 11,687 |
| Nantucket County | 724 | 8.0% | 162 | 5.0% | 9,105 |
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.