This past summer, the state of Louisiana sent text messages to just over 13,000 Medicaid enrollees, directing them to a website where they could confirm their incomes. The pilot program was part of a broader effort to test digital tools the Trump administration claims will help Medicaid recipients meet new requirements—working, studying, job training, or volunteering at least 80 hours per month—set to take effect in just over a year.
But the initial results were underwhelming. Only 894 recipients completed the quarterly wage check—a participation rate of less than 7 percent—according to Drew Maranto, Undersecretary for the Louisiana Department of Health. “We’re hoping to get more to opt in,” Maranto said. “We plan to raise awareness.”
The stakes are high. Officials in 42 states, plus Washington, D.C., must verify that roughly 18.5 million Medicaid enrollees meet these new work rules by the end of next year. The federal government has allocated $200 million to help states implement systems to track compliance. However, despite the funding, questions remain about the feasibility of these technological solutions.
The policy changes stem from a broader tax and spending law signed under Trump, aimed at freeing funds for priorities such as border security and tax cuts. Nonpartisan analysis by the Congressional Budget Office predicts that the new Medicaid work rules will reduce access to coverage for millions of Americans over the next decade, estimating 10 million fewer people will be insured by 2034—more than half due to the eligibility requirements.
Federal officials, including Mehmet Oz, director of the Centers for Medicare & Medicaid Services (CMS), have promoted these digital tools as a fast and easy way for enrollees to verify their incomes. Oz has suggested the process could be completed “within seven minutes,” claiming that today’s technology makes compliance simpler than ever before. Similarly, Brian Blase, president of the conservative Paragon Health Institute, has argued that artificial intelligence could allow enrollees to report their work or volunteer hours seamlessly.
Yet independent reporting by KFF Health News shows little evidence to support these claims. Federal and state agencies have released scant information on the pilots’ effectiveness. The technology currently being tested in Louisiana and Arizona connects directly to enrollees’ payroll websites but does not use AI to verify volunteer work, educational hours, or other qualifying activities.
State officials and health policy researchers worry the federal government may be overpromising. Medicaid is a state-administered program funded jointly by states and the federal government, meaning that even if federal officials tout a digital solution, the states must implement it themselves. “Oz can say, ‘Oh no, we’re going to fix this,’ but they don’t actually run the program,” said Joan Alker, a researcher at Georgetown University’s Center for Children and Families.
The pilot programs have raised more questions than answers. Arizona officials would not disclose participation numbers or outcomes for their pilot, noting it had only been used for SNAP eligibility verification, a smaller program than Medicaid. Similarly, in Louisiana, the pilot could only confirm income—not whether enrollees were meeting the broader work or volunteer requirements.
Other hurdles remain. Millions of Medicaid enrollees live in rural areas with limited internet access or unreliable cell service, making mobile-first digital solutions inaccessible to some of the very people the program aims to help. Even when tools exist, enrollees need to know about them and understand how to use them—a challenge not solved by technology alone.
Meanwhile, private vendors are pitching apps to states to help track work requirements, but many of these solutions are limited in scope and can only verify income. There is no “magical solution” that guarantees eligible individuals will maintain coverage, according to Jennifer Wagner, a researcher at the Center on Budget and Policy Priorities.
Louisiana and Arizona’s pilot programs underscore the complexity of administering Medicaid work rules in a country where systems vary widely, staffing is limited, and technology alone cannot solve structural issues. State and federal officials continue to experiment, but for millions of Americans, the threat remains that access to health care could be lost simply because the verification process is too complicated or the tools are inadequate.
As the deadline approaches, policymakers, advocates, and enrollees alike are watching closely, hoping that technology can meet the ambitious promises—but preparing for the reality that it might not.