Cowlitz Family Health Center predicts drop in Medicaid patients following federal changes

In what President Donald Trump calls an attempt to reduce waste and fraud, the One Big Beautiful Bill Act passed July 4 places stricter requirements on who can qualify for Medicaid.

At the Cowlitz Family Health Center, where just under half of all patients are on Medicaid, the new restrictions will likely lead to fewer people getting the medical care they need, CEO Jim Coffee said.

Coffee said the new rules will increase the administrative burden on his staff and cause patients to visit less frequently, leading to worse health outcomes. They may also limit the center’s ability to serve certain groups of immigrants.

On top of that, those patients are also frequently difficult to understand, he added.

“It’s, at the very least, very confusing all the way around,” Coffee said.

The center primarily serves low-income patients at about a dozen sites across the county, though its services are not income-restricted. Out of its 22,000 patients, about 10,000 were on Medicaid in 2024, Coffee said. He expects that number to drop once the new Medicaid restrictions go into effect, which they are scheduled to do in late 2026.

In 2024, about 3,500 of its patients were uninsured.

Uninsured patients visit the doctor less frequently, which often means that their health problems are more severe by the time they are able to access treatment, Coffee said.

New Medicaid requirements

The One Big Beautiful Bill Act requires all states to implement work requirements for Medicaid recipients aged 19-64. Exceptions are available for those unable to work for medical reasons and parents of children 13 or younger.

Under the new requirements, which are scheduled to go into effect by Dec. 31, 2026, people who qualify for Medicaid under the Affordable Care Act expansion must work at least 80 hours per month to receive benefits. Volunteer work and school enrollment can also count toward that time.

Currently, states are only allowed to implement work requirements if they apply for a waiver. As of July, Georgia is the only state with work requirements.

According to a 2024 analysis of the first year of Georgia’s work requirements by the Georgia Budget and Policy Institute, the program was costly to run and saw far fewer enrollments than expected, largely because of the complicated application process.

Coffee said he is concerned the Cowlitz Family Health Center will see similar results among its patients. In addition, Washington’s high minimum wage may make it difficult for people to find work that does not put them over the income limits for Medicaid, he said.

To qualify for Apple Health, Washington’s Medicaid program, a single-person household must make $1,800 per month or less. That means a person making minimum wage, $16.66, could only work up to 108 hours per month, or 27 hours per week, before they are over the income limit.

Also starting at the end of 2026, states will be required to recertify Medicaid recipients’ eligibility every six months rather than yearly. Coffee said that recertifying all 10,000 Medicaid recipients at the Cowlitz Family Health Center twice a year would make it difficult for administrative staff to complete other work.

Fewer qualified immigrants

Only some immigrants qualify for Medicaid, and those that do must generally wait five years after qualifying before they are able to apply.

The One Big Beautiful Bill Act limits the category of qualified immigrants to lawful permanent residents, some Haitian or Cuban immigrants and citizens of the Freely Associated States. Refugees, asylum seekers and humanitarian parolees will no longer qualify starting Oct. 1, 2026.

Undocumented immigrants already do not qualify for Medicaid, but may be covered by some state-funded programs, such as Washington’s Apple Health Expansion.

A 1996 federal law, the Personal Responsibility and Work Opportunity Reconciliation Act, states that undocumented immigrants and other nonqualified immigrants cannot receive any federal public benefits. It provides some exceptions for nonprofits, benefits that are not based on income and necessary lifesaving services.

The Cowlitz Family Health Center currently falls under one such exception. However, the federal Department of Health and Human Services posted a proposed rule July 14 that broadens the definition of federal public benefits to include community health centers, Head Start and a number of other programs.

The center does not collect information about patients’ immigration status, so it’s difficult to say how many would be affected by the new rules, Coffee said.

“We don’t categorize people other than the fact that we take care of them as our patients,” he said.