A new federal Medicaid work mandate poses significant risks to California’s estimated 180,000 homeless population, with medical professionals warning that many could lose coverage beginning in 2027. The mandate requires able-bodied adults younger than 65 without dependent children to complete 80 hours or more of work monthly to maintain Medicaid eligibility. The law also requires states to verify income and other eligibility criteria every six months, compared to once per year previously.
State officials estimate that up to 2 million people—approximately 14 percent of California’s 14 million Medi-Cal recipients—will lose coverage either because they cannot meet work requirements or become overwhelmed by the paperwork. Brett Feldman, a physician assistant leading the street medicine team at USC Keck School of Medicine, warned that “it’s very possible over 90% of people experiencing unsheltered homelessness will lose insurance.” Research demonstrates that homeless individuals have far worse health outcomes and a lifespan nearly 20 years shorter than the general population.
The law includes exemptions for those unable to work, including people with substance use disorders, disabling mental health conditions, complex medical conditions, and other disabilities. However, claiming exemptions requires a doctor’s certification. Only 39 percent of insured and unhoused Californians have a primary care provider, and in Los Angeles, just 7 percent of the homeless population had seen a provider in the past year between 2022 and 2023. This gap means many eligible people could lose coverage despite qualifying for exemptions.
State Medicaid officials are developing an automated eligibility verification system to minimize harm and spare people the need to prove qualifications manually. The system would pull workforce data, IRS information, and data from other welfare programs to verify eligibility. However, gaps remain, particularly regarding volunteer work verification and potential requirements for medical diagnosis codes to be reverified every six months. Street medicine providers and healthcare experts warn that despite automation efforts, eligible people will likely “fall through the cracks” due to frequent relocation of homeless populations and the difficulty of maintaining continuous contact.
This article is an AI-assisted summary. All facts and figures are drawn from the original report: https://lostcoastoutpost.com/2026/mar/5/trumps-medicaid-work-mandate-could-kick-thousands/