After months of nationwide uncertainty over looming threats to Medicaid, a clearer — but still murky — road now lies ahead for public health leaders across the Commonwealth. Over 300,000 Massachusetts residents — nearly 5 percent of the state’s population — are expected to lose Medicaid coverage by 2034 under the One Big Beautiful Bill Act.
The sweeping changes will likely hit hardest the state’s Gateway Cities, which are home to a disproportionate share of the state’s immigrants and low-income population, as work requirements and eligibility checks ramp up. During a 2023 Medicaid enrollment purge, MassHealth — the state’s Medicaid and Children’s Health Insurance Program — identified 15 “priority communities” that officials believed had the most residents at risk of losing coverage — 13 of which were Gateway Cities.
Some Gateway City leaders say they expect to take on the burden of educating enrollees, keeping them insured under new requirements, and helping disadvantaged communities navigate the approaching changes to MassHealth…