Native American Communities Face Medicaid Enrollment Challenges Amid New Work Requirements

Native American populations are expressing concerns about potential disruptions to Medicaid coverage as new work and eligibility requirements are set to be implemented by 2027. While federal law exempts Native Americans from the recent mandate that requires some Medicaid recipients aged 19 to 64 to work or participate in qualifying activities for at least 80 hours per month, the community still faces procedural risks that could lead to disenrollment. The recent 'unwinding' — the process of resuming eligibility checks after temporary protections during the COVID-19 public health emergency — resulted in nearly 27 million Americans losing Medicaid coverage, many due to administrative errors and procedural delays.

For Native Americans like Jonnell Wieder from Montana, complexities in the enrollment process have created significant hurdles. Wieder, a member of the Confederated Salish and Kootenai Tribes, relied on Medicaid and tribal health benefits to care for herself and her daughter, Oakleigh. When renewing her daughter's coverage, she encountered extensive delays and administrative issues that took six months to resolve, illustrating the systemic difficulties in maintaining continuous coverage.

Despite protections, Native Americans are still at risk of losing coverage due to procedural disenrollments, especially as states ramp up eligibility checks and implement new requirements. Tribal health officials highlight that effective communication, staff training, and updated procedures are essential to prevent disenrollments. As Congress enforces new stipulations, experts warn that Native communities could face increased coverage gaps, exacerbating existing health disparities.

The challenges are compounded by logistical obstacles such as unreliable mail service, limited internet access, and transient housing that complicate eligibility redeterminations. Past experiences during the unwinding revealed widespread issues, including thousands of wrongful disenrollments due to state system errors. Tribal leaders remain vigilant, advocating for policies that uphold trust and treaty obligations and ensure Medicaid remains a stable source of healthcare for Native Americans.

Looking ahead, experts emphasize the importance of lessons learned during the unwinding to prevent further loss of coverage. State agencies are preparing by launching educational campaigns and streamlining processes to assist tribal members in maintaining their health coverage amid ongoing federal policy changes. Ensuring that Native American communities are protected from procedural disenrollments remains a top priority to address longstanding health disparities and uphold their healthcare rights.

Source: https://medicalxpress.com/news/2025-08-native-americans-medicaid-enrollment-snafus.html