State workers bustled inside Ferrisburgh Town Hall on a recent afternoon, arranging rows of folding chairs and queuing up a slideshow in the main room. On the modest stage, Department of Vermont Health Access Commissioner DaShawn Groves and deputy commissioner Leslie Wisdom took their seats at a table, ready to explain the coming Medicaid changes to the people who will have to contend with them.
Nearly 50,000 low-income Vermonters will be subject to new requirements beginning next year. The state had invited the public to come learn what is changing and ask questions.
The officials waited.
The rows of chairs stayed empty.
State employees, one staffer from U.S. Sen. Peter Welch’s (D-Vt.) office and two reporters had come. But not a single Medicaid enrollee showed up.
Groves and Wisdom gave the presentation anyway.
They laid out how a sweeping federal budget law signed by President Donald Trump last year is about to make it harder for tens of thousands of Vermonters to maintain Medicaid coverage.
The first wave of pain is expected on Thursday, October 1, when an estimated 235 Vermonters will lose Medicaid because of restrictions tied to their immigration status. Beginning January 1, additional eligibility rules — including work requirements and twice-yearly reviews — will limit new applicants and gradually expand to an estimated 49,000 low-income adult Vermonters when they next renew their coverage.
State officials and community organizers are mobilizing to help Vermonters understand the new system and whether they qualify for the insurance. The number of people who ultimately lose coverage — whether they no longer qualify or simply fail to navigate a more demanding administrative system — could have wider consequences: Patients could delay medical care, and unpaid bills could further strain Vermont’s struggling health care system.
For the relatively small group of noncitizens losing coverage this October, the alternatives are limited. Some could purchase subsidized insurance through Vermont Health Connect, the state’s insurance marketplace, according to the Office of the Health Care Advocate. But federal restrictions on that coverage also tighten January 1. Others may need to seek financial assistance directly from hospitals.
“This is really devastating for these Vermont families,” health care advocate Mike Fisher said.
Even figuring out who is affected has proved complicated.
Bridges to Health, which helps immigrant and migrant Vermonters navigate health care, worked with 556 people on nearly 600 Medicaid enrollments and renewals in 2025. Naomi Wolcott-MacCausland, the organization’s director, initially identified six clients potentially affected by the new rules. After closer review, however, none appears on track to lose coverage now because their circumstances have since changed.
“The intersection of health insurance eligibility and immigration status has been confusing forever,” Wolcott-MacCausland said. The latest changes have made it harder not only for people applying for insurance, she added, but also for the workers trying to help them.
Other organizations serving immigrant Vermonters have been trying to sort through those distinctions. The Vermont Afghan Alliance has distributed information about the changes in Dari and Pashto, hosted Medicaid clinics in conjunction with Vermont Legal Aid, and steered clients to people trained to help them enroll in health coverage, according to executive director Ellen Yount.
Many of the alliance’s clients hold special immigrant visas and will remain eligible for Medicaid, Yount said. But she sees the federal changes in a broader context. Many Afghans came here after working alongside the U.S. government as soldiers, interpreters, drivers and security workers.
“The U.S. government made a promise to Afghans,” Yount said, including that it would help ensure their safety and security in the United States. “Sadly, at least at the federal government, we’re not keeping those promises.”
The alliance had employed a full-time health and wellness officer to help clients navigate care and insurance in Dari and Pashto, but state funding for the position ended in August. Yount said the organization has lost its federal funding for next year.
The complexity of the new immigration restrictions has prompted a broader multilingual outreach effort. Working with the state, the Vermont Language Justice Project produced videos about the changes in 10 languages and distributed them through social media and community networks, including WeChat to reach Mandarin speakers.
Alison Segar, director and founder of the project, said videos can reach people who may never read a government notice or a news article. But producing this series has been unusually difficult, even for an organization accustomed to communicating about subjects such as postpartum depression.
“At the end of every video, I just feel really, really, really miserable and sad because this information is really devastating,” Segar said. “There’s nothing good about it at all.”
The rules coming in January will affect far more Vermonters.
The roughly 49,000 Medicaid recipients who will be subject to the new rules range in age from 19 to 64, according to Groves, the Department of Vermont Health Access commissioner. Beginning in the new year, people can generally satisfy the new requirements by showing that, in a month, they’ve earned at least $580 in household income; completed 80 hours of qualifying activities such as work, education or community service; or been enrolled half-time as a student. Those adults also will have to reestablish their Medicaid eligibility every six months instead of annually, starting on their next renewal date.
There are numerous exceptions, including for pregnant people, some parents and caregivers, and folks considered medically frail. Enrollment in some other benefit programs can also count toward meeting the requirement.
Groves said the state does not have an estimate for how many Vermonters will ultimately lose coverage. Fisher, the health care advocate, expects that the vast majority of those affected will meet the work requirement or qualify for an exemption. His bigger concern is that some people who remain eligible will be dropped because they cannot keep up with the additional paperwork and deadlines.
Denise Walton, 64, knows how burdensome the process can already be. The Concord resident, who receives Medicaid and disability benefits, recently completed a renewal application that ran 10 to 15 pages, she recalled. Walton has relied upon the program for years and considers herself relatively well informed. Still, she described the process as “very daunting,” particularly for someone encountering it for the first time.
That’s one reason Walton and other volunteers with the Vermont Workers’ Center, a grassroots organization based in Burlington that advocates for economic justice and health care rights, have been taking information to community lunches and other gathering places, rather than waiting for people to seek them out.
Walton was among the volunteers who gathered in downtown Brattleboro on September 19 for a rally against Medicaid cuts. They set up tables on the lawn outside Centre Congregational Church and offered a free meal, health screenings and information about the coming eligibility changes. A banner denouncing Medicaid cuts billowed in the fall breeze as pedestrians passed along Main Street and organizers led union anthems.
The gathering celebrated Brattleboro Memorial Hospital’s recent decision to keep its birthing center open. But for all the activity along the downtown strip, organizers were largely preaching to their own choir: Many of those gathered wore the red T-shirts of the Nonviolent Medicaid Army, a national network of patients and advocates organizing against cuts to the program.
The state, meanwhile, is trying to automate as much of the new process as possible. Groves said the Department of Vermont Health Access can use wage and food benefit data to verify whether some people meet the requirements without asking them for additional documents. When reliable data are unavailable, Vermont plans to allow people to independently confirm that they meet the criteria during the first year, though federal rules will limit that flexibility beginning in 2028.
Although the new requirements come from the federal government, states are responsible for running Medicaid within the guidelines. Putting the changes into effect will add work for Vermont, too. Officials from the Vermont Department of Health Access estimate that updating eligibility will increase their workload by roughly 30 percent, according to testimony to the state legislature earlier this year. The department has budgeted about $5 million for one-time systems changes, with federal funding expected to cover most of the cost. The added workload will also require ongoing state funding.
Sen. Ginny Lyons (D-Chittenden-Southeast), chair of the Senate Committee on Health and Welfare, has warned of costs beyond those to administer the new rules. Uninsured Vermonters may put off preventive care, medications or other treatment until their health problems become more serious — and more expensive to treat, Lyons said.
Hospital leaders share that concern. Mike Del Trecco, president and chief executive officer of the Vermont Association of Hospitals and Health Systems, said policies that jeopardize coverage could worsen patients’ health and drive up costs across the system.
“In Vermont, we have been focused on affordability, and these policy changes move us in the opposite direction,” Del Trecco said. “No matter what, our hospitals will be here to serve patients, no matter their ability to pay.”
We have been focused on affordability, and these policy changes move us in the opposite direction.
mike del trecco
That same promise anchors federally qualified health centers such as the Community Health Centers of Burlington, which treat patients regardless of whether they can pay.
But the Medicaid changes have brought uncertainty for patients and providers alike. Some patients are already carrying confusing notices into exam rooms, according to Adam Greenlee, the centers’ chief medical officer. The centers plan to devote more staff time to helping people navigate their coverage, but that work isn’t reimbursed, Greenlee said, which adds pressure to an organization that has already left some positions unfilled and streamlined its workforce to curb spending.
“Eventually we do run out of levers,” Greenlee said, at which point it could become harder for patients to access care.
Greenlee doesn’t know how many patients will lose coverage or put off care in the coming months. But he expects the consequences could take years to surface. Providers are still treating sicker, more complex patients after pandemic-era delays in care, he said, and experts have warned that the loss of enhanced Affordable Care Act subsidies could set off a similar cycle.
That puts a premium on reaching people before changes in coverage become gaps in care. The state has cast a wide net. It has mailed information to Medicaid households, sent text messages, advertised online and on the radio, created an online screening tool, and distributed materials through health care providers and community organizations. More than 200 professionals trained by the state are available to help people understand their coverage and enroll in health care.
But the Ferrisburgh event with state health officials showed there’s a difference between sending a message and knowing that it landed.
The Department of Vermont Health Access has scheduled its next town hall for December, just weeks before the new rules take effect. By then, the question won’t be how many chairs it can fill, but how many of the nearly 50,000 affected Vermonters know what they need to do. ➆
The original print version of this article was headlined “Undercovered | New Medicaid rules will affect thousands of Vermonters — and could add strain to the state’s beleaguered health care system”
This article appears in September 30 • 2026.
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