Beginning in January, tens of thousands of Mainers enrolled in MaineCare will face new work reporting requirements to keep their health care coverage. The new administrative burdens are the result of changes in President Trump’s “One Big Beautiful Bill” (OBBB) that used the savings from depriving millions of Americans health care to pay for tax cuts for the wealthy. In Maine MECEP estimates around 29,000 Mainers could lose MaineCare coverage as a result.
New Maine Center for Economic Policy projections find Maine’s most rural counties are likely to be the hardest hit. Mainers in those areas are more likely to rely on MaineCare for health care coverage because they are more probable to have low levels of income that qualify for MaineCare (for a single person living alone subject to the new work reporting requirement the MaineCare eligibility level is just over $22,000 per year). And rural Mainers are more likely to be unemployed or working irregularly, due to local economic conditions, making it more likely they will fail the new requirements.
Under the new law, most non-disabled MaineCare members ages 19 to 64 must prove they are either earning at least $580 a month or working, volunteering, or studying at least 80 hours per month to maintain their health care coverage. There are exemptions for parents of children age 13 or younger, pregnant people, and some other categories.
Even if people are meeting the requirements of the new law, outcomes from other states that have implemented similar requirements show large numbers of eligible people may still be excluded from coverage.
MECEP estimates the biggest impact of the cuts will be in Washington County, where over one third of the MaineCare expansion group will lose their coverage, representing 3% of the county’s population. Maine’s northern and western counties are also among those hardest hit. Meanwhile in Sagadahoc County, just over 1% of the population is likely to lose coverage.
While these are only projections of the potential impact, they illustrate the disparate fallout of the changes the Trump administration billed as cracking down on “waste, fraud, and abuse” that in reality will particularly hurt rural Mainers struggling to find consistent work or adequately navigate the new paperwork.
Methodology
Enrollment numbers for the MaineCare expansion group targeted by OBBB’s new provisions come from the Maine Department of Health and Human Services via the Maine Monitor. To determine what share of these enrollees would lose coverage, MECEP examined microdata from the US Census Bureau’s American Community Survey for the years 2022-2024.
From the microdata, MECEP began with the total number of Mainers receiving Medicaid age 19 to 64 and were not eligible for Medicare or Supplemental Social Security benefits (thus eliminating those who were certified as disabled by the Social Security Administration). MECEP then eliminated people who would be exempt from the work reporting requirement because they had a child under age 14 or had a personal income of at least $6,960 in the last year. Of the remaining population, MECEP assumed people who were unemployed or not in the labor force would fail the work requirement, as would those who were regularly working fewer than 20 hours per week. To account for administrative errors, MECEP followed modelling by the Robert Wood Johnson Foundation, and assumed 31% of employees and 51% of self-employed people who met either the hourly work requirement or the income requirement would still lose coverage.
Because the Census Bureau’s microdata does not allow for analysis at the county level for every county in Maine, MECEP relied on so-called Public-Use Microdata Areas (PUMAs), for the geographic variation in coverage loss across the state. MECEP calculated the share of Medicaid expansion enrollees who would lose coverage in each PUMA and then applied this rate to the 2025 enrollment numbers provided by DHHS.