‘We are terrified’: Gateway City leaders prepare for federal cuts, changes to Medicaid

July 24, 2025

By Hallie Claflin

After months of nationwide uncertainty over looming threats to Medicaid, a clearer — but still murky — road now lies ahead for public health leaders across the Commonwealth. Over 300,000 Massachusetts residents — nearly 5 percent of the state’s population — are expected to lose Medicaid coverage by 2034 under the One Big Beautiful Bill Act.

The sweeping changes will likely hit hardest the state’s Gateway Cities, which are home to a disproportionate share of the state’s immigrants and low-income population, as work requirements and eligibility checks ramp up. During a 2023 Medicaid enrollment purge, MassHealth — the state’s Medicaid and Children’s Health Insurance Program — identified 15 “priority communities” that officials believed had the most residents at risk of losing coverage — 13 of which were Gateway Cities.

Some Gateway City leaders say they expect to take on the burden of educating enrollees, keeping them insured under new requirements, and helping disadvantaged communities navigate the approaching changes to MassHealth. 

For now, these communities are doing the best they can to prepare for the thousands of residents expected to lose health coverage while they wait for more guidance from the state. Some are coordinating with their local or regional health centers and hospitals, while others are organizing targeted outreach and relying on community ties.

President Trump and Congressional Republicans’ reconciliation bill, signed into law on July 4, calls for non-disabled adult recipients under 65 to work, train, or volunteer for at least 80 hours per month starting as early as January 2027. Eligibility checks will be required every six months instead of yearly. Many immigrants with legal status will no longer be eligible, including refugees, people granted asylum, and certain abused spouses, children, and trafficking victims. 

“We are being forced to do things that really shouldn’t fall on local government,” said Chelsea City Manager Fidel Maltez. “We are terrified, because we have seen it time and time again. When the federal government does not step in, residents show up at our doorstep. They ask for help, and we’re in the front lines.”

Elvira Pinjic, executive director of the Joint Committee for Children’s Healthcare in Everett, runs a team of certified health insurance navigators that operates rent-free out of Everett City Hall and works closely with the city to provide education and assistance to low-income residents. Nearly 47 percent of the city is foreign-born, which is significantly higher than the state average of 18 percent. More than 15 percent of residents had an income below the poverty level in 2023.

Requiring enrollees to re-up their eligibility twice a year means “double the work,” Pinjic said. Once they receive more guidance from the state on what kinds of paperwork will be required, the team plans to use their database to reach out to MassHealth enrollees via WhatsApp, social media, and other avenues to answer questions, offer help, and send reminders. They are also partnering with churches throughout the city to spread the word about significant changes to MassHealth.

“You would go to your city hall first, before you go anywhere else,” Pinjic said. “They’re not going to go to the state … they will come to us to ask these questions.”