The Medicaid work requirements take effect January 1, 2027. The people they push off Medicaid are not the ones who die in a crisis. The danger is quieter than that, and it’s already here. For those affected, having a mental health plan is more important than ever.
On January 26 this year, a family in Queens called 911 and asked for an ambulance. Their son, Jabez Chakraborty, has schizophrenia. They told the dispatcher he had no weapon and nobody was hurt. The police came instead. Body-camera video shows him at the door with a knife. An officer fired four times. He lived, in an ICU, in restraints. “We did not call the police,” the family said afterward. In moments like these, a mental health plan can make a crucial difference.
No new law caused that. It happened under the system we have right now. Hold onto that, because the system we have right now is about to get more crowded.
On January 1, 2027, a Medicaid rule kicks in. Adults covered through the expansion have to prove 80 hours a month of work, school, or volunteering, and prove it again every six months. The Congressional Budget Office says the requirement cuts $326 billion in federal spending and leaves 5.3 million more people uninsured by 2034. That is the whole design. The savings are the people who fall off.
Here’s the part that sounds reasonable, and I understand why. Able-bodied adults should work. Most people believe that, and I’m not going to insult them for it. But we already ran this test. Arkansas put in a work requirement in 2018. Eighteen thousand people lost coverage in a few months. Employment didn’t go up. Researchers found more than 95 percent of the people targeted already met the rule or should have been exempt. They lost coverage anyway, because they missed a letter, or the website failed, or nobody told them the rule existed. The requirement didn’t sort the lazy from the working. It sorted the people who could manage the paperwork from the people who couldn’t. For those managing chronic illness, establishing a mental health plan is often essential for navigating these complexities.
Now ask who struggles with paperwork and proof of hours. It’s the person working gig shifts that change every week. The renter who moved twice this year, because a record 22.7 million renter households, by Harvard’s housing center’s count, now pay more than they can carry. It’s the worker who, in the American Psychological Association’s 2025 survey, is one of the 44 percent bracing for a layoff. Economic instability is exactly what makes a clean 80-hour report impossible to keep. The rule punishes the instability it pretends not to see.
Check out the mental health memoir: Until the. Well Runs Dry
I want to be precise, because the other side won’t be. Most people in a violent psychotic crisis are not covered through the expansion group. They qualify through disability, and the work rule doesn’t touch them. And no, this rule won’t directly produce the next Queens shooting. The damage is quieter. It falls on the person with depression or a substance use disorder who was stable because Medicaid paid for the medication and the counselor. Take the coverage, and you take the stability. In June, the administration narrowed the medical exemption so a diagnosis alone no longer excuses you. You have to prove your illness “significantly impairs” you. That test will drag some genuinely sick people into the same gauntlet of letters and deadlines. Stability is what keeps a bad week from becoming a crisis. This rule removes it on a schedule. Let’s not forget our military veterans.
Ninety days after the rule starts, another clock runs out. On March 31, 2027, the enhanced federal match that pays 85 cents on the dollar for Medicaid mobile crisis teams expires, and Congress hasn’t renewed it. That doesn’t switch the teams off overnight. States can keep paying at the ordinary rate, and some will. California just put in $42.2 million to hold its program through the middle of 2027. But Denver spent this fall fighting over a $1.5 million cut to its STAR responders during a deficit, and one California county penciled its loss at up to $1.2 million a year. When the federal share drops, the teams thin. They thin unevenly, and they thin first in the places with the least money, which are the same places where the crisis calls come most.
Who answers, then, when the clinician is gone? The same responder who answered in Queens. In New York City, even in the neighborhoods with a non-police mental health team, police still handled 86 percent of mental health 911 calls this year. Where there’s no team, it’s nearly all of them. Nationally, police killed more than 1,200 people in 2025, by Mapping Police Violence’s tally. At least 116 were reached during a call about a mental health crisis or erratic behavior. Black Americans are 12 percent of the country and 26 percent of the dead. In a study of more than four million emergency-room visits, a Black patient had 38 percent higher odds of arriving in police custody than a white one. This is the machine as it runs today. Nobody has to guess what happens when you feed it more people. You only have to look at who it already takes. That is why a mental health plan is vital for those at risk.
The honest version is strong enough that I don’t need to inflate it. Economic instability makes the work rule impossible to satisfy. The work rule strips coverage from people whose stability depended on it. And a crisis system that already answers with a badge instead of a nurse is losing the money for the alternative in the same quarter. Three steps. Each one documented. You don’t need a body with the law’s fingerprints on it to see where this goes.
Two things, and Congress can do both before the clock runs. Delay the work requirement, or repeal it, because it doesn’t create jobs and it does cost coverage. That is not my opinion. It is the Arkansas record. And make the 85 percent mobile crisis match permanent. A bipartisan bill to do exactly that was introduced in September. States don’t have to wait, either. They can accept a signed attestation instead of demanding a fresh stack of proof from a sick person twice a year.
The family in Queens asked for someone to come help their son. They got four gunshots and a bed with straps on it. They were told, in effect, that the only responder the city could promise carried a gun. We’re about to make that the promise for more families, in more cities, and we are doing it on purpose, with a start date. A country that can schedule the cut can schedule the fix. The date is the same. January 1. We know it’s coming. That’s the one advantage we have. Furthermore, for every individual impacted by these changes, developing a mental health plan could provide essential guidance and support through uncertain times.
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