For five years, a New York gig worker went without coverage. Inconsistent jobs and unpredictable income kept insurance out of reach, so he skipped care and acted as “his own doctor.” When he finally got on Medicaid, he called it “the best insurance I’ve ever had—even better than private insurance.”
A woman who moved to the country and became pregnant while uninsured, with her husband earning very low income, discovered Medicaid at the hospital during prenatal visits. She called it a “great deal” that covered everything from delivery to medicine.
A recent college graduate, still unable to land a full-time job with benefits, feels like she’s “failing somehow.” She makes too little to afford a marketplace plan, yet depends on Medicaid for weekly therapy and monthly prescriptions.
Three very different lives, one shared reality: people whose healthcare access rests on a government program about to change dramatically.
The 2025 budget reconciliation bill, known as the One Big Beautiful Bill Act, slashes nearly a trillion dollars from Medicaid over the next decade through work requirements, stricter eligibility checks, and reduced retroactive coverage periods. But it comes at a high cost. Projections show 10 million people losing coverage, hospital net income dropping by more than 70%, and $63 billion in additional uncompensated care.
For patients, it’s survival. For providers, solvency, not to mention service. The question now is whether providers can do more than brace for impact—whether they can help patients keep Medicaid coverage before they fall through the cracks.
To explore this, we spoke with the people at the center of it all: Medicaid beneficiaries. Their perspectives reveal which patients are most at risk of losing coverage, and the specific ways providers can help preserve their access to care.
Medicaid patients will do whatever it takes to keep their coverage
Our conversations confirmed that patients understand the stakes of the Medicaid changes. What we didn’t expect was the intensity of their motivation to navigate whatever requirements lie ahead.
The pragmatism was striking. When asked about sharing employment details and income documentation, patients didn’t hesitate. “I would do whatever it takes to keep my Medicaid benefits,” said a freelance writer from New York. Even patients who found the requirements “degrading” said they’d comply.
Some spoke from experience. One self-employed worker already navigating SNAP work requirements had to write detailed letters explaining his affiliate marketing work to bureaucrats unfamiliar with gig economy jobs. The process was “ridiculous,” he said, but he did it anyway. “I answer truthfully and honestly and I don’t hide any money.”
However, willingness to comply might not be enough for patients to maintain eligibility. During the Medicaid “unwinding” in 2023 and 2024, 69% of coverage losses were due to procedural reasons rather than ineligibility—suggesting motivation wasn’t the issue, but system navigation was. This creates a clear opening for provider intervention.
Here’s the thing: if I have to do that to keep my health insurance, I’ll do it. But quite frankly, it feels degrading.
A Medicaid beneficiary on sharing employment and income details with providers
But Medicaid patients don’t believe their providers can or will help
At first, participants dismissed the idea of providers getting involved with work requirements or bi-annual redeterminations. “I don’t think they’ll be able to help me or anybody else,” one said. “That’s a lot of work for them to do in addition to what they already do.” Another was more blunt: “I think they’re not gonna help one bit. They’re gonna be like, that’s not our problem.”
Digging deeper, patients draw a clear line between their providers and insurance—or, more specifically, the government agencies administering Medicaid. Some even feel the system is adversarial, with no one in their corner. This perception is likely compounded by declining institutional trust overall. A recent JAMA study found that trust in physicians and hospitals dropped from 71.5% to 40.1% between 2020 and 2024.
This artificial boundary creates a perception gap. Patients who trust providers with life-and-death decisions often assume those same providers can’t help with paperwork that affects access to care. In reality, providers have built entire teams around financial assistance and insurance verification workflows.
Yet when the conversation shifted from abstract provider involvement to specific operational support, patient enthusiasm was unmistakable. They wanted robust reminder systems (“I don’t think there are enough times I could be reminded”), simple checklists breaking down new requirements, and proactive alerts through patient portals.
The bottom line: Patients may not assume providers can help with coverage, but that assumption can be flipped. When support is tangible, actionable, and visible, patients respond. The opportunity isn’t in just building new capacity; it’s also in making existing support obvious.
When I think of health insurance, that feels like a personal thing. I guess I never thought a doctor’s office would help me outside of explaining my benefits.
A Medicaid beneficiary on providers’ role in helping navigate Medicaid changes
Bridging the trust gap with a persona-driven approach
Patients are clearly motivated to comply with the Medicaid changes. While they don’t always expect help from providers, they want it—and express their needs in different ways.
Understanding these differences can help providers identify where targeted support can help patients stay covered, reduce administrative burden, and ensure patients stay on track with critical care. From our conversations, three distinct Medicaid personas emerged:
Given these unique challenges, there are targeted interventions providers can deploy to help these patients keep their Medicaid coverage. And these approaches aren’t mutually exclusive.
Like a curb cut on a sidewalk, originally designed for people in wheelchairs but also helping parents with strollers, delivery workers, and anyone rolling a suitcase, each of the following strategies can make life easier for many Medicaid patients as the changes take effect.
1. Streamline administrative complexity
The Proactive Gig Worker is highly motivated to use a digital solution. They would find it “helpful” and “beneficial” because it would streamline a cumbersome process like reporting monthly work hours. What’s more, they would be comfortable sharing sensitive documents with a trusted provider if it means they can stay on top of new requirements and avoid the hassle of dealing with bureaucracy.
2. Provide proactive guidance
The Anxious Caretaker benefits most from clear, early communication that cuts through bureaucratic confusion. They want simplified information delivered through trusted channels—straightforward checklists, timeline reminders, and step-by-step guidance that helps them stay organized without adding to their overwhelm. Solutions should give them a sense of control and security, making sure they don’t miss a deadline that could jeopardize their family’s health.
3. Enable medical advocacy
The Medically-Fragile Patient’s engagement is driven by necessity. They are motivated to use any tool that can help them prove their medical need to the government. They would be the ideal user for a solution that allows their provider to directly advocate on their behalf, for example, by submitting medical documentation to validate their eligibility.
Even when this persona no longer qualifies for Medicaid, providers should prioritize connecting these patients to alternative assistance programs—such as medication copay assistance or patient support programs—to ensure uninterrupted access to life-sustaining treatments.
Final thought
Medicaid patients aren’t passive. They’re pragmatic, motivated, and—even when it feels degrading—willing to play by the rules. What they lack, from their perspective, is not effort but allies. And that’s where providers have a choice: to maintain the status quo or to make their support visible.
The challenge, of course, is scale. Even well-resourced financial assistance teams can only go so far when requirements tighten for millions of patients at once. That’s why it’s worth asking: what would these changes mean for your own patient population and bottom line?
To help answer that, we built an assessment tool to model the potential financial impact of Medicaid cuts. It translates coverage losses into uncompensated care and revenue pressure, helping leaders see the risks clearly and act on patient needs that might otherwise go quietly unmet.
About the research
This analysis is based on interviews with 20 current Medicaid beneficiaries about their sentiment toward the One Big Beautiful Bill Act in July 2025. Participants were recruited from both Medicaid expansion and nonexpansion states, representing diverse employment situations and eligibility pathways, including income-based enrollment and disability coverage.
The interviews used open-ended questions to explore participants’ awareness of policy changes, specific coverage concerns, and perspectives on potential provider support, with responses analyzed to identify common themes.
Images displayed are not of the participants.
Researchers
Jaya Birch-Desai is Director of Research at Cedar
Riti Shah is Senior Researcher at Cedar
