LEXINGTON, Ky. — Major changes to Kentucky's Medicaid program taking effect in January 2027 could strip coverage from thousands of eligible residents who cannot meet stricter work requirements, healthcare advocates and policy experts warned.

The changes stem from the One Big Beautiful Bill Act, signed into law in July 2025, which mandates that eligible adults complete 80 hours per month of work, volunteering, job training, or community service to maintain Medicaid coverage.

Emily Beauregard, executive director of Kentucky Voices for Health, said the state's Medicaid department faces significant implementation challenges. "Our Kentucky Medicaid department is still trying to understand how they'll implement these incredibly complicated new requirements and that's on top of state budget cuts to Medicaid that put us at risk of losing state workers and providers," Beauregard said.

The greatest concern is that eligible Kentuckians will lose coverage due to bureaucratic barriers, Beauregard explained. She cited the example of a cancer patient undergoing chemotherapy who cannot work: under the new rules, they must prove their condition prevents them from meeting the 80-hour requirement and submit documentation as evidence. Missing a deadline means losing coverage and risking medical debt.

"Because of the paperwork, because of the more frequent reporting requirements, and even our most vulnerable people who are medically frail, they have health conditions that can make it difficult to work consistently," Beauregard said.

Kayla Harmon, a Warren County resident, said families like hers already face obstacles to maintaining employment. "We're doing the best we can with what we have. Sometimes we've got those barriers, like transportation's a barrier. How are we going to get to and from?" Harmon said.

The American Medical Association has warned that the new rules are expected to increase healthcare costs and worsen patient access to care. Research from the Kentucky Center for Economic Policy found that populations most vulnerable to Medicaid cuts are concentrated in the state's eastern and southern counties.