Administratively Ineligible. How Medicaid Cuts Are Quietly Disconnecting Patients From Care

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By a daughter, a caregiver,

Tomi Love BSN RN

Future Family Nurse Practitioner &

Founder, The People's Medic

Ten years of fighting

My mom has been a caregiver her whole adult life. She worked as a CNA for years, doing the kind of hands-on, bedside work that doesn't pay enough, doesn't get recognized enough, & doesn't ever really stop.

In 2016, she was diagnosed with BRCA-positive, HER2-positive breast cancer, & her career caring for other people ended as much as she protested it and kept pushing through for her patients; she needed to care for herself now.

She has been fighting for ten years. Chemotherapy regimen after chemotherapy regimen. Some worked for a few months & stopped. Others did nothing at all.

Earlier this year, her oncology team finally landed on a targeted therapy that started shrinking her tumors. For the first time in a long time, we had hope.

When the bill came due

In July 2025, the One Big Beautiful Bill Act, or as I call it, The Biggest Bullshit Bill, was signed into law. The bill cut roughly one trillion dollars in federal Medicaid funding over the next decade & gutted two of the programs that were keeping my mom alive: her ACA low-income coverage & her orphan drug pathway.

The therapy that was covered for years, & was finally working, now costs roughly $14,000 per month out of pocket.

She said to me, "Tomi, I'd rather die. I can't afford that. "

The silent policy

What happened to my mom is the part most people don't see. She did not become medically ineligible for her treatment. She did not stop qualifying clinically.

She became administratively ineligible, & that distinction is by design.

She is a U.S. citizen who paid into this system her entire hard-working life."

The programs built to protect her

The Affordable Care Act, signed in 2010, was the largest expansion of U.S. healthcare coverage since Medicare & Medicaid were created in 1965. It extended Medicaid eligibility up to 138% of the federal poverty level, created the marketplace exchanges, made it illegal for insurers to deny coverage for preexisting conditions, & provided income-based subsidies that millions of families relied on.

The Orphan Drug Act of 1983 was designed to encourage development & coverage of treatments for rare diseases that drug companies would otherwise have no incentive to pursue.

Both programs were specifically built to protect patients like my mom.

H.R. 1 quietly hollowed out both.

Did you know you still pay for Medicare after you retire?

Most people think Medicare is free once you hit 65. It's not. You pay into it your whole working life through payroll taxes, & then you pay it again every single month after you retire. The standard Part B premium is over $200 a month in 2026, & it comes straight out of your Social Security check before you ever see it. If your income is higher, you can pay close to $700 a month. Most of what's left of your Social Security raise this year got eaten up by that premium increase alone.

So even the program everyone thinks of as the "free" safety net for seniors is quietly taking a bite out of the same check people are relying on to survive. & that's the system working as designed. Now imagine what happens when the rest of the safety net gets rewritten on purpose.

This is what's actually in the bill

This January 2026 outlook, that Bullshit Bill introduced 80-hour-per-month work requirements, shortened Medicaid eligibility redeterminations from 12 months to 6 months for the expansion population beginning December 2026, & lowered the cap on the provider taxes states use to fund their Medicaid programs.

On paper, these look like reasonable accountability measures. In practice, they create a maze of paperwork & deadlines that disenroll people without ever formally declaring them ineligible. The system simply forgets them.

That's the part nobody talks about. It's not that people stop qualifying. It's that the paperwork outruns them. A redetermination notice is sent to an address that has changed. A work-hour log doesn't get submitted on time because someone's job is cash-based or unpredictable. Nobody sends a denial letter. There's just silence, & then no coverage.

We saw this same playbook on a smaller scale with Medicare. The cost is built quietly into a system people assume is already paid for. With Medicaid under H.R. 1, the mechanism is different, but the outcome is the same: people lose ground without anyone ever telling them they did.

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How this looks on the streets

At The People's Medic, we do street outreach, harm reduction, & free clinic days right here in Las Vegas.

For our unhoused neighbors, the math is even more brutal. Many do not have a stable mailing address to receive notices. Many cannot prove their work hours in cash or gig-economy jobs. Many were never connected to a primary care provider in the first place, so the loss of coverage hits without any clinical relationship to fall back on.

This is what social determinants of health look like in real time. Housing instability, food insecurity, transportation barriers, & chronic stress do not just predict worse outcomes. They directly determine whether someone can clear the administrative hoops needed to keep their coverage in the first place.

And we know what is coming. The BBB provisions, the full work requirements & shortened renewal cycles, do not take full effect until December 2026 & into 2027.

What we are seeing in our community right now is a preview. Unfortunately, we are preparing for it to get much worse.

The real answer is universal healthcare.

We can keep patching holes in the floor, or we can replace the floor.

The United States already spends more per capita on healthcare than any other high-income country & still leaves tens of millions of people uninsured or underinsured. The money to cover everyone is already in the system. It is just being absorbed by private insurance overhead, billing complexity, & administrative churn instead of reaching patients.

A federal universal healthcare program, in line with current Medicare for All proposals, would decouple coverage from employment, income paperwork, & political administration.

It would mean my mom, along with many others, does not lose her treatment. It would mean our unhoused neighbors are not chasing eligibility paperwork from the streets. It would mean nurses, NPs, & doctors could focus on patient care rather than billing.

2 protections we are fighting for right now

While we organize for the bigger fight, we are also pushing for two immediate protections that could be implemented now:

First, require states to automatically renew Medicaid & marketplace eligibility using data they already have, like tax records, SNAP enrollment, & prior eligibility files. This is called ex parte renewal, & it would stop disenrollment for paperwork reasons alone.

Second, a federal continuity-of-care provision that keeps coverage in place for patients in active oncology or other ongoing treatment until that treatment is finished or safely transitioned.

These two changes alone would prevent a large share of the preventable coverage losses we are already seeing in our community.

What we are doing about it

Our standard is simple: Always Free Healthcare and Education.

The People's Medic has always been built on the understanding that the safety net is full of holes, & our job is to be in those holes with our neighbors. The Biggest Bullshit Bill is widening those holes faster than the existing infrastructure can patch them.

So we are responding.

• We are expanding our Sidewalk Sundays outreach & free clinic days to meet rising demand.

• We are connecting newly uninsured patients with enrollment navigators, offering free healthcare pro bono through our business Releaf Healthcare, & finding patient assistance programs wherever they exist.

• We are training more community members through our Medic Preparedness classes so the work does not depend on a small group of paid providers.

• We are showing up at city council, the state legislature, & congressional offices to demand continuity-of-care protections, automatic ex parte renewal, & the broader fight for universal healthcare.

We refuse to let our neighbors suffer. Especially from a system aware of its outcome.

How can you help?

If you or someone you love is facing a loss of coverage, reach out. We can connect you with enrollment support, offer services, & find patient assistance programs.

If you are a healthcare worker, organizer, or community member in Southern Nevada, join us!

We need more volunteers on Sidewalk Sundays, more trained Medics, responders, & more voices!

If you have the means, donate. Every dollar goes directly into outreach supplies, clinic days, & community health education.

Donate Here

Reflection time!

Let's hear from you.

Have you or someone you love been affected by changes to Medicaid or ACA coverage under the BBB? 

What did the experience look like for your family or community? Drop a comment, send us a message, or share this post with someone who needs to know they are not alone in it.

My mom spent her working life taking care of other people. She does not deserve to be one of the people the system quietly walks away from. None of them do.

We are bracing what we do, & we are not backing down.

In solidarity,

Tomi

The People's Medic

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• Yes, I did!
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Reference:

KFF. (2026, January 23). Medicaid: What to watch in 2026. https://www.kff.org/medicaid/medicaid-what-to-watch-in-2026/