A new Urban Institute analysis warns that up to 2.3 million young adults (ages 19–24) could lose Medicaid coverage by 2028 as a result of work requirements and more frequent eligibility checks introduced by the "One Big Beautiful Bill Act" (OBBB) signed by President Trump. The sweeping legislation is projected to cut Medicaid spending by nearly $1 trillion over a decade and requires adults in expansion states to document 80 hours of work, education, or volunteer activity per month to maintain coverage.

Here's the catch: roughly 88% of affected young adults already meet the work requirements or qualify for an exemption — but states often lack the data to verify it automatically. Young adults are especially vulnerable because they move frequently and engage in gig work, both of which are notoriously hard for state systems to track. Without proactive state intervention, many eligible enrollees could lose coverage simply due to paperwork barriers.

By the Numbers:

• 2.3M young adults could lose Medicaid in a low-mitigation scenario
• 1.1M could lose coverage even in a high-mitigation scenario
• Medicaid expansion enrollment among young adults could drop 22%–48% depending on state implementation
• 5M–10M total Medicaid enrollees are expected to lose coverage overall

Why it matters: The scale of potential coverage loss hinges almost entirely on state-level choices — not eligibility. States that invest in automated data matching and targeted outreach could cut losses significantly, while those that don't risk pushing millions of qualifying young adults off the rolls through administrative attrition alone.