This summer, the state of Louisiana sent text messages to just over 13,000 people on Medicaid with a link to a website where they could verify their income.
The texts were part of a pilot project to test technology that the Trump administration says will make it easier for some Medicaid enrollees to prove they meet new requirements—working, studying, training or volunteering at least 80 hours a month—that take effect in just over a year.
But only 894 people completed the quarterly paycheck, or just under 7% of participants who received the text, according to Drew Maranto, Louisiana's deputy secretary of health.
“We hope more people will agree,” Maranto said. “We plan to raise awareness.”
Officials in 42 states (excluding those that did not expand Medicaid at all) and Washington, D.C., will have to figure out how to verify that the roughly 18.5 million Medicaid enrollees comply with the rules included in President Donald Trump's tax and spending bill. They have until the end of next year, and federal officials are giving those jurisdictions a total of $200 million to do so.
The policy change is one of several that would free up money for Trump's priorities, such as improved border security and tax breaks that largely benefit the wealthy.
The nonpartisan Congressional Budget Office said that work rules will be the main reason millions of people will not be able to access health insurance over the next decade. Changes to the Medicaid program are estimated to result in 10 million fewer Americans being covered by 2034—more than half of them due to eligibility rules.
For now, government officials, health policy researchers and consumer advocates are overseeing a pilot program in Louisiana and another in Arizona. Mehmet Ozdirector of the Centers for Medicare and Medicaid Services, touted the test drives and said they would allow people to verify their income “within seven minutes.”
“There have been attempts to do this in the past, but they couldn't achieve what we can achieve because we have the technology now,” Oz said. during a television appearance in August.
Brian Blase, president of the conservative Paragon Health Institute and a key architect of the new law's Medicaid changes, chimed in, saying during recent radio appearance that with today's artificial intelligence, “people should be able to seamlessly determine how they spend their time.”
KFF Health News found scant evidence to support such claims. Federal and state officials have said little about what new technology the two pilots tried. However, they say it connects directly to the websites of Medicaid enrollees' payroll providers, rather than using artificial intelligence to draw conclusions about their activities.
Oz said the Trump administration's efforts began “as soon as the bill was signed” in July. But working on pilot programs started under the Biden administration.
And Medicaid is a federal-state program: the federal government contributes most of the funds, but it must be administered by the states, not the federal government.
“Oz might say, 'Oh no, we're going to fix this. We're going to do it.” Well, they don't actually run the program,” said Joan Alkerhealth policy researcher at the Georgetown Center for Children and Families.
Officials also provided few details about the effectiveness of the pilot projects in helping enrollees in Medicaid or other public benefit programs.
Because of the lack of information, some state officials and health policy researchers are concerned that the Trump administration does not have viable solutions to help states implement the operating rules. As a result, they say, people who are legally eligible for Medicaid benefits could lose access to them.
“What really keeps me up at night is the fear that Medicaid-eligible members trying to get health care services will fall through the cracks and lose coverage,” said Emma Sando, Oregon Medicaid director.
Officials involved in the projects in Louisiana and Arizona declined to answer many specific questions about their efforts, instead referring KFF Health News to federal officials.
Arizona Medicaid and Economic Security officials — Johnny Cordoba and Brett Besio, respectively — would not share data on how many people took part in the state's pilot testing or describe its results. They said the pilot was used to test eligibility only for the federal Supplemental Nutrition Assistance Program, a smaller program than Medicaid.
Community Food Bank of Southern Arizonaa nonprofit that helps people sign up for such SNAP benefits had not heard of the pilot program.
State officials and health policy researchers have said that no pilot program can confirm whether a person meets other qualifying activities, such as community service, or any of the many exceptions. Tested tools can only test income.
Andrew Nixon, director of public affairs for the U.S. Department of Health and Human Services, which oversees Oz's agency, wrote in a statement that the digital tools officials are seeking to share with states are “largely a work in progress.”
One person I'm working on this development This is Michael Burstein, who until recently worked for the US Digital Service, which later became known as the Department of Government Effectiveness.
When the US Digital Service was transformed into DOGE, Burstein and other employees left and founded a non-profit organization called Digital Public Works complete technology support to make it easier for people to certify their income for Medicaid.
But without permission from government officials, Burstein wouldn't describe the tool in development other than to say it's mobile-first and can quickly verify a new or returning customer's income, “and we're very happy with it.”
Government agencies that administer benefit programs such as Medicaid and SNAP are understaffed and use different selection systems. many of which need updatingmaking improving them “a challenge,” he said.
The $200 million in startup costs that the federal government has committed to work requirements tracking systems is about four times what it cost to single-handedly administer Georgia's Medicaid employment program.
The state, which has the nation's only active work requirement program called Georgia Pathways to Insurance, received temporary extensiondespite recent report from a federal watchdog saying it did not receive sufficient federal oversight. A complex registration process the number of program participants turned out to be much lower than Georgia's own forecasts.
Trump's tax and spending law allows states to ask for more time — until the end of 2028 — to begin enforcing the rules, but only with the approval of HHS Secretary Robert F. Kennedy Jr. It also allows counties with high unemployment will be exempt from taxbut states must apply for this exemption.
Even with an app that states can use to certify that people are eligible for Medicaid, enrollees still need to know that the app exists and how to use it—neither of which is a given, Alker said. There is also no guarantee that they will have reliable cell phone service or Internet access. How This was reported by KFF Health News.millions of Americans live in rural areas without reliable internet.
Private vendors are also working on such applications, he said. Jennifer Wagnerwhich examines Medicaid eligibility and enrollment at the Center on Budget and Policy Priorities. Wagner said she saw several vendors demonstrating products they plan to sell to states under the operating rules. Many of them are limited in scale, like those used in pilot tests, she said.
“No one has a magic solution that will ensure that eligible people don’t lose coverage,” she said.
KFF health news is a national newsroom that produces in-depth journalism on health issues and is one of the core operating programs of KFF, an independent source of health policy research, polling and journalism. Find out more about KFF.
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