Keeping Medicaid Coverage: How mobile clinics can prevent disenrollments

The One Big Beautiful Bill Act introduces three simultaneous Medicaid requirements that will interact to produce coverage losses driven by administrative complexity, not ineligibility. This brief examines the Arkansas precedent, identifies three failure modes states should anticipate, and makes the case for mobile health clinics as community-based retention infrastructure.

Key Points

• The One Big Beautiful Bill Act (OBBBA) creates three new requirements starting late 2026 that will eliminate millions of people from Medicaid rolls. The vast majority will lose coverage due to paperwork failures, not because they no longer qualify.
• When Arkansas implemented work requirements, one in four affected enrollees lost coverage. Nearly all were still eligible but could not navigate the complex administrative systems.
• Mobile health clinics offer a practical solution: every patient visit becomes a chance to check enrollment status, help with required paperwork, and document exemptions before a coverage lapse occurs.
• States that invest in community-based retention will save money through lower emergency care costs, preserved federal funding, and fewer people cycling on and off the rolls.

What the Law Changes

The OBBBA changes Medicaid in three ways that will work together to push people off their health coverage. Each creates a different challenge, and together they will be far harder to manage than any one alone.

Work requirements

Adults ages 19 to 64 who receive Medicaid through their state’s expansion program must now report 80 hours per month of work, community service, or school enrollment. Those who cannot meet this threshold must document a qualifying exemption. These rules take effect December 30, 2026. Importantly, anyone who loses Medicaid for not meeting the work requirement is also blocked from receiving subsidized marketplace coverage. There is no fallback. This makes it critical that community-based providers help eligible individuals stay enrolled before a lapse occurs.

Twice-as-frequent eligibility checks

States must now verify that expansion enrollees still qualify for Medicaid every six months instead of once a year. A RAND Corporation analysis projected that this change alone will cause 923,000 people to lose coverage by 2034, while the work requirement will push 5.3 million more off the rolls.

Cuts to safety net funding

The law reduces the taxes and supplemental payments states use to fund hospitals and clinics that serve Medicaid patients. As these providers lose revenue, some will close or stop accepting Medicaid. When patients lose access to a provider, they stop engaging with the healthcare system, miss renewal paperwork, and eventually lose coverage through inaction.

None of these changes operate in isolation. A patient who loses their nearby clinic (funding cuts), misses a renewal notice (six-month check), and cannot document their work hours (work requirement) faces three separate paths to losing coverage at the same time.

What Happened in Arkansas

Arkansas is the only state that has tried Medicaid work requirements at scale. According to the Urban Institute, roughly 18,000 people (one in four of those subject to the requirement) lost coverage in the first seven months. Research consistently found that the policy had no measurable positive effect on employment.

The coverage losses were overwhelmingly caused by paperwork problems, not ineligibility. People who qualified for exemptions or who were already working enough hours lost their Medicaid because they could not figure out or access the state’s reporting system. Many only discovered they had lost coverage when they tried to see a doctor or fill a prescription. They reported that they had not received or understood state notices. Adults without home internet access were hit hardest, since the state relied on an online portal for reporting.

State officials involved in Arkansas’s outreach found that the hardest-to-reach enrollees did not answer calls from unknown numbers and frequently changed addresses. Traditional outreach methods simply did not work for this population. This is precisely where mobile health clinics, which maintain regular, in-person contact with underserved communities, offer a fundamentally different approach.

Arkansas tested only work requirements in isolation. The OBBBA layers work requirements on top of twice-yearly eligibility checks on top of provider funding cuts. States should expect the combined effect to be significantly worse than anything Arkansas experienced.

Three Reasons People Will Lose Coverage They Still Qualify For

They never get the message

The biggest driver of coverage loss in Arkansas was not noncompliance but unawareness. Mailed notices, automated calls, and online portals consistently fail to reach people in rural and underserved communities. These individuals move frequently, distrust unknown callers, and may lack reliable internet. Mobile health clinics that visit communities on a regular schedule create an alternative channel: a trusted, face-to-face relationship where enrollment information can be shared at every visit. When a clinic checks enrollment status at every patient encounter, fewer people fall through the cracks.

The paperwork is too complicated

The work requirement demands monthly documentation of either 80 hours of qualifying activity or a qualifying exemption. Many people most likely to qualify for medical exemptions (those with chronic conditions, substance use disorders, or undocumented disabilities) already receive healthcare where the clinical record could directly support their case. A mobile clinic that integrates enrollment assistance into every visit can generate the exemption documentation at the same appointment where the patient receives care. This eliminates the gap between getting medical help and completing required paperwork.

They lose access and stop trying

When a nearby clinic closes or stops taking Medicaid, patients disengage from healthcare entirely. Once they disengage, they miss renewal notices and redetermination deadlines. They lose coverage through inaction, not ineligibility. Mobile health clinics directly counter this by bringing care to communities where fixed-site options have disappeared. Maintaining a patient’s connection to the healthcare system simultaneously maintains their connection to the Medicaid enrollment system.

Why Prevention Saves States Money

States that simply let eligible people lose coverage will pay for it in three ways. First, people who lose Medicaid but still need care will show up in emergency rooms as uninsured patients. Those costs flow back to the state budget. Second, every eligible person who falls off the rolls represents federal matching dollars the state failed to collect. Third, re-enrolling someone who was improperly dropped costs more than keeping them enrolled in the first place.

The OBBBA already requires states to build new systems to handle six-month eligibility checks and work requirement verification. States that design those systems to share enrollment data with community providers (including mobile clinics, community health centers, and rural clinics) will get a dual return: compliance with the new law and a built-in retention tool. Notifying a mobile clinic that a patient’s renewal deadline is approaching costs very little but prevents an expensive downstream failure.

What States Can Do Now

Build enrollment help into clinical visits

Instead of creating separate outreach programs, states can embed enrollment verification, renewal assistance, and exemption documentation into the clinical visits already happening at mobile health clinics, community health centers, and rural clinics. This uses existing trusted relationships and closes the gap between healthcare and paperwork.

Focus resources where the risk is highest

States should identify communities where the risk of paperwork-driven coverage loss is greatest: rural areas, places where hospitals or clinics have recently closed, and communities that experienced high rates of procedural loss during the 2023-2024 Medicaid unwinding. These are the places where mobile health clinics and targeted enrollment support will have the largest impact.

Share enrollment data with community providers

The new compliance infrastructure states must build should push enrollment status and deadline information to the community providers who see patients face to face, not keep it locked inside the eligibility agency. When a mobile clinic knows which patients face an upcoming deadline, it can act before coverage lapses instead of reacting afterward.

Contract with mobile health providers for enrollment retention

Mobile clinics that operate on regular schedules in underserved communities combine clinical care, trusted relationships, and administrative help in one visit. States should develop contracting mechanisms that recognize and fund the enrollment retention work these providers do alongside their clinical services.

The implementation timeline is short. States must notify enrollees by September 2026 if they plan to implement work requirements by the December 2026 start date. The time to build retention infrastructure is now.