The Struggle to Navigate America’s Overwhelmed Medicaid System

When Calling for Help Becomes an Impossible Task

For Katie Crouch, a 48-year-old Delaware resident living with the lasting effects of a severe brain aneurysm, something as simple as calling her state’s Medicaid office has become an exercise in frustration. Her experiences paint a vivid picture of a system stretched far beyond its capacity: endless ringing phones, voicemails that abruptly disconnect, transfers that lead nowhere, and calls where no one is actually on the other end. For months, Crouch tried desperately to confirm whether her Medicaid coverage had been renewed, a question that should have a straightforward answer but instead became an odyssey of failed attempts. The stakes were high—without confirmation of her Medicaid renewal, she was suddenly responsible for $200 monthly Medicare deductibles that had previously been covered, placing significant strain on her family’s limited fixed income. Her situation isn’t an isolated case of bad luck or bureaucratic inefficiency in one state; rather, it represents a widespread crisis affecting millions of Americans who depend on Medicaid for their healthcare needs. State Medicaid agencies across the country are struggling to maintain adequate staffing levels to help people enroll in benefits and answer basic questions from those already in the program. This shortage of workers creates a cascade of problems that prevent people from fully accessing benefits they’re legally entitled to receive, leaving vulnerable populations in precarious situations.

New Requirements Adding Pressure to an Already Broken System

The challenges facing state Medicaid offices are about to become significantly worse. The One Big Beautiful Bill Act, signed into law by President Donald Trump, will impose sweeping new demands on state agencies in the nearly all states and the District of Columbia that expanded Medicaid to cover more low-income adults. Beginning January 1, 2027, state workers will be required to implement and monitor new work requirements for millions of Medicaid enrollees, verifying that recipients meet employment criteria to maintain their coverage. Additionally, the law changes how frequently states must verify that people qualify for the program—doubling the frequency from once a year to twice a year, every six months. This legislation is projected to reduce Medicaid spending by nearly $1 trillion over the next eight years, but the human cost may be substantial. When KFF Health News contacted state agencies that will need to implement these new work rules, many acknowledged they would need to hire additional staff to handle the increased workload. However, finding and training these workers is no simple task, and many states are already operating with significant staffing shortages. Health policy experts, consumer advocates, and former state agency officials have warned that these new mandates will place additional strain on a workforce that is already overwhelmed, making it even more difficult for people like Katie Crouch to get basic customer service and potentially causing millions to lose access to healthcare benefits they legally qualify for.

The Evidence Shows States Are Already Struggling

The data paints a troubling picture of a system barely keeping its head above water. The Centers for Medicare & Medicaid Services tracks whether states can process the most common type of Medicaid application within a 45-day window—a reasonable timeframe for people who need healthcare coverage. Yet in December, approximately 30% of all Medicaid and Children’s Health Insurance Program (CHIP) applications in Washington, D.C., and Georgia took longer than 45 days to process. More than a quarter exceeded that deadline in Wyoming, and in Maine, one in five applications missed the mark. The call center statistics are equally alarming. Since CMS began publicly sharing state Medicaid call center data in 2023, the extent of the problem has become undeniable. In Hawaii, people waited on hold for more than three hours in December. Callers in Oklahoma waited for nearly an hour, and those in Nevada for more than an hour. These aren’t minor inconveniences—for someone dealing with a health crisis or trying to understand their coverage before a crucial medical appointment, these wait times can have serious consequences. The situation worsened during the 2023 Medicaid unwinding process, when states began reviewing whether enrollees who had been protected from losing coverage during the COVID-19 pandemic still qualified for the program. This process didn’t go well in many states, and more than 25 million people lost their benefits. Health policy researchers and consumer advocates say implementing the new work requirements will be an even bigger challenge, requiring extensive changes to IT systems and new training for eligibility workers—all on a very tight timeline.

The Human Face of System Failure

Katie Crouch’s story illustrates how system failures translate into real hardship for real people. After months of unsuccessful attempts to reach someone at Delaware’s Medicaid office, she finally got answers only after writing to U.S. Representative Sarah McBride’s office. The congresswoman’s staff contacted the state Medicaid agency, which eventually called Crouch with an update. The news was shocking: Crouch didn’t qualify for Medicaid after all. Even more bewildering was that this fact had never come up during two years of interactions with the state agency. “It makes absolutely no sense” that the state never realized she shouldn’t have been on the program, Crouch said. Her case raises troubling questions about how many other people might be in similar situations—either receiving benefits they don’t qualify for due to administrative oversights, or conversely, being denied benefits they should be receiving because the system is too overwhelmed to properly process their cases. Delaware’s Medicaid agency didn’t respond to requests for comment on Crouch’s situation, leaving unanswered questions about how such a fundamental error could persist for so long. The situation highlights a broader truth that health policy experts emphasize: losing Medicaid coverage isn’t just an inconvenience. Many people enrolled in the program don’t earn enough money to pay for healthcare on their own and may not qualify for financial assistance to purchase coverage through the Affordable Care Act marketplace. Without Medicaid, people may be unable to afford necessary medications or get essential medical care, leading to what experts describe as “devastating” health impacts.

States Scrambling to Find Staff They Can’t Afford

When KFF Health News reached out to states in late March to ask how they planned to handle the new work requirements, the responses revealed the depth of the staffing crisis. Idaho reported having 40 eligibility worker vacancies. New York estimated it would need 80 new employees to handle the additional administrative work, at a cost of $6.2 million. Pennsylvania has nearly 400 open positions in county human services offices across the state. Indiana’s Medicaid agency has 94 unfilled positions. Maine wants to hire 90 additional staff members, and Massachusetts is looking for 70 more. Montana had filled only 39 of the 59 positions state officials projected it would need as of early March, yet the state still plans to roll out the new rules early, starting July 1, despite ongoing struggles with system backlogs that applicants say have delayed their benefits. Perhaps most striking is Missouri’s situation. The state’s social services agency has cut staff significantly, now employing about 1,000 fewer frontline workers than it did roughly a decade ago—while simultaneously serving more than double the number of people enrolled in Medicaid and the Supplemental Nutrition Assistance Program (SNAP). Jessica Bax, the agency director, explained during a November public meeting that “the department thought that there would be a gain in efficiency due to eligibility system upgrades,” but acknowledged that “many of those did not come to fruition.” Finding people willing to take these jobs is particularly difficult because the positions require months of training, can be emotionally draining, and typically offer low pay. As one researcher with experience running a state Medicaid customer service program put it: “They get yelled at a lot. People are frustrated. They’re crying. They’re concerned. They’re losing access to healthcare, and so sometimes it’s not an easy job to take if it’s hard to help someone.”

The Profitability of Administrative Complexity

While states struggle to find adequate staffing, private contractors are stepping in to fill the gap—and making significant profits in the process. Maximus, a major government services contractor, provides eligibility support such as running call centers in 17 states that expanded Medicaid, interacting with nearly three in five people enrolled in the program nationally. During a February earnings call, company leadership revealed that Maximus charges based on the number of transactions it completes for enrollees, independent of how many people are actually enrolled in a state’s Medicaid program. This payment structure has significant implications: the company reported bringing in $1.76 billion in 2025 from the part of its business that includes Medicaid work, and executives expect that revenue to continue growing even as people lose their Medicaid coverage. As the company’s chief financial officer explained, this growth will happen “because of the additional transactions that will need to take place” under the new requirements. The irony is stark—a system designed to provide healthcare to low-income Americans and people with disabilities has created a lucrative business model based on the administrative complexity of determining eligibility and processing frequent reverifications. Meanwhile, Republicans argue the Medicaid changes will encourage enrollees to find jobs, though research on previous Medicaid work requirement programs has found little evidence they actually increase employment. What the evidence does show is that these requirements are highly effective at reducing the number of people with health coverage. The Congressional Budget Office estimated that the work rules will cause more people to lose health coverage by 2034 than any other part of the GOP budget law, potentially affecting more than 5 million people. As one senior attorney with the National Health Law Program pointedly stated: “The human stakes of this are people’s lives.”