{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T19:12:05Z","timestamp":1784056325062,"version":"3.55.0"},"reference-count":22,"publisher":"Oxford University Press (OUP)","issue":"7","license":[{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000133","name":"Agency for Healthcare Research and Quality","doi-asserted-by":"publisher","award":["R18HS027389"],"award-info":[{"award-number":["R18HS027389"]}],"id":[{"id":"10.13039\/100000133","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,7,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Forthcoming H.R.1 Medicaid eligibility changes requiring documentation of work, school, or volunteer activities are projected to result in significant disenrollment. High-risk beneficiaries, including those experiencing homelessness, are more likely to experience barriers in navigating the eligibility process, such as qualifying for work requirement exemptions. We utilized an existing set of linked data across the medical safety net, state Medicaid agency, housing services providers, and justice agencies as a case study to understand the prevalence of select potential medical and social exemptions from work requirements, examine safety net system utilization to identify potential touch points to prevent coverage loss, and estimate medical costs to inform planning and resourcing efforts to support continued enrollment. We found a high prevalence of Medicaid members potentially exempt from work requirements and of interactions with the medical safety net and with housing service providers specifically within the group experiencing homelessness. Increased medical costs that would likely shift to the safety net if coverage loss occurred demonstrate an opportunity for community efforts to support enrollment. Our case study can serve as a model for other communities proactively to plan for the local impact of H.R.1 eligibility changes, including data integration, coordination, and support efforts.<\/jats:p>","DOI":"10.1093\/haschl\/qxag162","type":"journal-article","created":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:15:45Z","timestamp":1782864945000},"source":"Crossref","is-referenced-by-count":0,"title":["Minimizing H.R.1-related Medicaid coverage disruptions for high-risk patients"],"prefix":"10.1093","volume":"4","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4899-9768","authenticated-orcid":false,"given":"Rachel M","family":"Everhart","sequence":"first","affiliation":[{"name":"Ambulatory Care Services, Denver Health , Denver, CO 80204 ,","place":["United States"]},{"name":"Department of Medicine, University of Colorado Anschutz Medical Campus School of Medicine , Aurora, CO 80045 ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Gillespie","sequence":"additional","affiliation":[{"name":"Urban Institute Housing and Communities Division, , Washington, DC 20024 ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-7514-8232","authenticated-orcid":false,"given":"Marcella","family":"Maguire","sequence":"additional","affiliation":[{"name":"Corporation for Supportive Housing Strategy and External Affairs, , NewYork, NY 10006 ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7071-8910","authenticated-orcid":false,"given":"Sarah A","family":"Stella","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Colorado Anschutz Medical Campus School of Medicine , Aurora, CO 80045 ,","place":["United States"]},{"name":"Department of Medicine, Denver Health , Denver, CO 80204 ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1721-5919","authenticated-orcid":false,"given":"Rebecca","family":"Hanratty","sequence":"additional","affiliation":[{"name":"Ambulatory Care Services, Denver Health , Denver, CO 80204 ,","place":["United States"]},{"name":"Department of Medicine, University of Colorado Anschutz Medical Campus School of Medicine , Aurora, CO 80045 ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tracy L","family":"Johnson","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Colorado Anschutz Medical Campus School of Medicine , Aurora, CO 80045 ,","place":["United States"]},{"name":"Health Policy Solutions , Golden, CO 80403 ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,7,1]]},"reference":[{"key":"2026071415021091200_qxag162-B1","author":"US Congress"},{"key":"2026071415021091200_qxag162-B2","author":"US Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation"},{"key":"2026071415021091200_qxag162-B3","author":"Department of Health and Human Services, Centers for Medicare & Medicaid Services"},{"key":"2026071415021091200_qxag162-B4","author":"Congressional Budget Office"},{"issue":"1","key":"2026071415021091200_qxag162-B5","doi-asserted-by":"publisher","first-page":"306","DOI":"10.1257\/pol.20200561","article-title":"Employed in a SNAP? The impact of work requirements on program participation and labor supply","volume":"15","author":"Gray","year":"2023","journal-title":"Am Econ J Econ Policy."},{"key":"2026071415021091200_qxag162-B6","doi-asserted-by":"publisher","DOI":"10.1377\/forefront.20251001.497575","article-title":"Medicaid's new address verification requirements could impose significant burdens","author":"Maguire","year":"2025","journal-title":"Health Aff Forefront"},{"issue":"11","key":"2026071415021091200_qxag162-B7","doi-asserted-by":"publisher","first-page":"E875","DOI":"10.1001\/amajethics.2021.875","article-title":"How Medicaid and states could better meet health needs of persons experiencing homelessness","volume":"23","author":"Charania","year":"2021","journal-title":"AMA J Ethics"},{"key":"2026071415021091200_qxag162-B8","author":"Corporation for Supportive Housing"},{"key":"2026071415021091200_qxag162-B9","author":"Ganguly"},{"key":"2026071415021091200_qxag162-B10","author":"Gillespie"},{"key":"2026071415021091200_qxag162-B11","author":"Colorado Department of Health Care Policy & Financing"},{"key":"2026071415021091200_qxag162-B12","author":"3M Health Information Systems"},{"issue":"1","key":"2026071415021091200_qxag162-B13","doi-asserted-by":"publisher","DOI":"10.13063\/2327-9214.1181","article-title":"Augmenting predictive modeling tools with clinical insights for care coordination program design and implementation","volume":"3","author":"Johnson","year":"2015","journal-title":"EGEMS (Wash DC)"},{"issue":"1","key":"2026071415021091200_qxag162-B14","doi-asserted-by":"publisher","first-page":"49","DOI":"10.1186\/s40352-023-00248-3","article-title":"No health without access: using a retrospective cohort to model a care continuum for people released from prison at an urban, safety net health system","volume":"11","author":"Frank","year":"2023","journal-title":"Health Justice"},{"issue":"16","key":"2026071415021091200_qxag162-B15","doi-asserted-by":"publisher","first-page":"3113","DOI":"10.1007\/s11606-024-08909-1","article-title":"Improving identification of patients experiencing homelessness in the electronic health record: a curated registry approach","volume":"39","author":"Stella","year":"2024","journal-title":"J Gen Intern Med"},{"key":"2026071415021091200_qxag162-B16","author":"Pestaina"},{"key":"2026071415021091200_qxag162-B17","author":"US Department of Health and Human Services"},{"issue":"4","key":"2026071415021091200_qxag162-B18","doi-asserted-by":"publisher","first-page":"567","DOI":"10.1377\/hlthaff.2019.01594","article-title":"Health and human services integration: generating sustained health and equity improvements","volume":"39","author":"Fichtenberg","year":"2020","journal-title":"Health Aff."},{"key":"2026071415021091200_qxag162-B19","author":"Hinton"},{"key":"2026071415021091200_qxag162-B20","author":"Musumeci"},{"key":"2026071415021091200_qxag162-B21","author":"Diana"},{"key":"2026071415021091200_qxag162-B22","author":"Serafi"}],"container-title":["Health Affairs Scholar"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/healthaffairsscholar\/advance-article-pdf\/doi\/10.1093\/haschl\/qxag162\/68663974\/qxag162.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/healthaffairsscholar\/article-pdf\/4\/7\/qxag162\/68663974\/qxag162.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/healthaffairsscholar\/article-pdf\/4\/7\/qxag162\/68663974\/qxag162.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T19:02:17Z","timestamp":1784055737000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/healthaffairsscholar\/article\/doi\/10.1093\/haschl\/qxag162\/8722812"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,1]]},"references-count":22,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2026,7,3]]}},"URL":"https:\/\/doi.org\/10.1093\/haschl\/qxag162","relation":{},"ISSN":["2976-5390"],"issn-type":[{"value":"2976-5390","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,7]]},"published":{"date-parts":[[2026,7,1]]},"article-number":"qxag162"}}