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New from CommonWealth Beacon OPPORTUNITY KNOCKS?: Hidden among the cuts to social welfare programs in President Trump’s budget reconciliation bill was a provision that builds on “Opportunity Zones” — an initiative of Trump’s first term aimed at lifting up poor communities. Whether the program delivered on its promise is still up for debate, Jennifer Smith reports. PROMOTING CANNABIS: The Joint Committee on Cannabis Policy heard testimony on Tuesday about an issue that has been bubbling up in the industry: Should cannabis companies be allowed to advertise, run discounts, or have sales? Bhaamati Borkhetaria reports. ***MUST READ! IN-DEPTH ANALYSIS!**** OPINION: Should Massachusetts repeal its 2024 gun control law? Repeal advocates say it goes too far in restricting rights; opponents say it builds sensibly on the state’s already strong gun-control laws, former Secretary of Education James Peyser writes.

‘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.

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“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.”

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More Context 5 Key Facts About Medicaid Work Requirements (February 2025) 5 ways ‘Big Beautiful Bill’ would affect Massachusetts (July 2025)

More from CommonWealth Beacon CANADIAN OFFSHORE: With wind projects blocked at home because of the federal hostility to wind energy, Massachusetts is looking north to Canadian offshore wind for clean, affordable energy. Bhaamati Borkhetaria reports. HEALTHY PRICING: State regulators on Monday rejected proposed rate hikes from Blue Cross Blue Shield of Massachusetts and WellSense Health Plan — the second- and third-largest carriers in the merged market, respectively, reports Chris Lisinski of the State House News Service. Meanwhile, hundreds of thousands of Massachusetts residents on other plans will see their premiums increase by 7 percent to 12 percent next year. UNEXPECTED STOP: Eight Red Line train cars shipped to the US from China are being detained at the Port of Philadelphia, Bruce Mohl reports, raising concerns about whether the MBTA’s long-running effort to replace its aging subway fleet will encounter additional delays.

What We're Reading COURTS: Two judges fired from a Massachusetts immigration court say they see their terminations as part of President Trump’s broader attack on the nation’s court system. More than half of the judges at the Chelmsford court, the state’s largest immigration court, have been let go or quit since January. (WBUR) ENERGY: As Vineyard Wind has ramped up construction at the New Bedford Marine Commerce Terminal, the project is now sending power from 17 wind turbines to the Massachusetts grid. It amounts to about 220 megawatts of the 800-megawatt project, or 27% power production, with enough energy to power more than 100,000 homes. (The New Bedford Light)   IMMIGRATION: Health and home care providers in Massachusetts have recently laid off staff because of the Trump administration’s crackdown on immigration. Those providers say losing workers is a problem as the need for aging senior care grows. (GBH News) ENVIRONMENT: According to a new report from Switchbox — a New York climate policy think tank — there’s a way for Massachusetts residents to reduce the costs of electricity while the state works to achieve its climate goals: widespread adoption of air-source heat pumps. (MassLive – paywall) EDUCATION: For district superintendents across Massachusetts, the ramp up in immigration enforcement during the Trump administration has created many challenges. For one, it has been an extra responsibility to provide emotional support to students and families impacted. (WBUR)

Massachusetts leans into artificial intelligence This week on The Codcast, it’s the state angle on artificial intelligence. CommonWealth Beacon reporter Jennifer Smith talks with Sabrina Mansur, director of the Massachusetts Artificial Intelligence (AI) Hub. Mansur explains how she uses AI in her daily life and why keeping Massachusetts competitive means a $100 million taxpayer-funded effort to get into the AI race. LISTEN NOW

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