Medicaid Coverage at Risk
Michigan county-level estimates of Medicaid enrollees in categories affected by P.L. 119-21 work requirement provisions (Urban Institute, March 2026). All figures are modeled ranges — not point estimates. Exposure is not disenrollment.
This page combines measured public data with projections from named sources. All projected values are labeled and dated. accessmi.org does not produce original forecasts; we surface the most current publicly available data from CBO, GAO, MDHHS, MLPP, CBPP, USDA, and other named sources.
Exposure is not disenrollment
These figures identify Michigan Medicaid enrollees who fall into categories that Urban Institute, CBO, and CBPP project may be affected by P.L. 119-21 work requirement provisions. Being in an affected category is not the same as losing coverage. Individual outcomes depend on state implementation decisions, work requirement compliance pathways, income and employment changes, and administrative factors. The ranges describe populations at elevated exposure — they do not predict who will or will not retain Medicaid enrollment. Full methodology →
Statewide projection
171,000–355,000
Michigan adults in categories affected by P.L. 119-21 work requirement provisions (Urban Institute projection, 2028 horizon)
Work requirement provisions only
(Modeled estimate)Most current public data: Urban Institute — P.L. 119-21 Medicaid work requirements, March 2026.
$31.6 billion
Michigan federal Medicaid spending reduction over 10 years under P.L. 119-21 (KFF, December 2025)
All P.L. 119-21 Medicaid provisions
(Projected)Most current public data: KFF — Allocating CBO's Federal Medicaid Spending Reductions, December 2025.
83
Michigan counties — complete statewide coverage (all 83)
Statewide coverage
Most current public data: U.S. Census Bureau county list, 2026.
County breakdown
modeled range — not a point estimate | modeled range — not a point estimate | ||
|---|---|---|---|
| Wayne | 1,135,450 | 31,286 | 64,950 |
| Oakland | 781,100 | 21,522 | 44,680 |
| Macomb | 544,100 | 14,992 | 31,124 |
| Kent | 414,361 | 11,417 | 23,702 |
| Genesee | 256,052 | 7,055 | 14,647 |
| Washtenaw | 220,717 | 6,082 | 12,625 |
| Ottawa | 187,877 | 5,177 | 10,747 |
| Ingham | 174,776 | 4,816 | 9,998 |
| Kalamazoo | 162,893 | 4,488 | 9,318 |
| Saginaw | 118,492 | 3,265 | 6,778 |
| Livingston | 118,136 | 3,255 | 6,758 |
| Muskegon | 108,699 | 2,995 | 6,218 |
| St. Clair | 97,204 | 2,678 | 5,560 |
| Jackson | 96,492 | 2,659 | 5,520 |
| Berrien | 95,324 | 2,627 | 5,453 |
| Monroe | 94,866 | 2,614 | 5,427 |
| Calhoun | 84,179 | 2,319 | 4,815 |
| Allegan | 75,028 | 2,067 | 4,292 |
| Eaton | 66,894 | 1,843 | 3,826 |
| Bay | 62,759 | 1,729 | 3,590 |
| Lenawee | 59,203 | 1,631 | 3,387 |
| Grand Traverse | 58,258 | 1,605 | 3,332 |
| Lapeer | 52,817 | 1,455 | 3,021 |
| Midland | 51,282 | 1,413 | 2,933 |
| Clinton | 48,849 | 1,346 | 2,794 |
| Van Buren | 47,159 | 1,299 | 2,698 |
| Shiawassee | 41,597 | 1,146 | 2,379 |
| Isabella | 39,433 | 1,087 | 2,256 |
| Marquette | 38,988 | 1,074 | 2,230 |
| Montcalm | 38,659 | 1,065 | 2,211 |
| Barry | 38,437 | 1,059 | 2,199 |
| Ionia | 38,075 | 1,049 | 2,178 |
| St. Joseph | 37,988 | 1,047 | 2,173 |
| Tuscola | 31,749 | 875 | 1,816 |
| Cass | 31,333 | 863 | 1,792 |
| Newaygo | 30,729 | 847 | 1,758 |
| Hillsdale | 28,038 | 773 | 1,604 |
| Branch | 27,024 | 745 | 1,546 |
| Sanilac | 24,636 | 679 | 1,409 |
| Mecosta | 24,358 | 671 | 1,393 |
| Gratiot | 23,339 | 643 | 1,335 |
| Delta | 21,983 | 606 | 1,257 |
| Houghton | 21,499 | 592 | 1,230 |
| Wexford | 20,735 | 571 | 1,186 |
| Emmet | 20,431 | 563 | 1,169 |
| Chippewa | 20,169 | 556 | 1,154 |
| Clare | 18,620 | 513 | 1,065 |
| Huron | 18,617 | 513 | 1,065 |
| Mason | 17,637 | 486 | 1,009 |
| Alpena | 17,265 | 476 | 988 |
| Oceana | 16,213 | 447 | 927 |
| Charlevoix | 15,428 | 425 | 883 |
| Dickinson | 15,410 | 425 | 881 |
| Otsego | 15,324 | 422 | 877 |
| Gladwin | 15,278 | 421 | 874 |
| Iosco | 14,957 | 412 | 856 |
| Cheboygan | 14,917 | 411 | 853 |
| Manistee | 14,308 | 394 | 818 |
| Antrim | 14,035 | 387 | 803 |
| Osceola | 13,991 | 386 | 800 |
| Menominee | 13,488 | 372 | 772 |
| Roscommon | 13,431 | 370 | 768 |
| Leelanau | 13,199 | 364 | 755 |
| Ogemaw | 12,204 | 336 | 698 |
| Kalkaska | 10,774 | 297 | 616 |
| Benzie | 10,690 | 295 | 611 |
| Missaukee | 9,193 | 253 | 526 |
| Arenac | 8,812 | 243 | 504 |
| Gogebic | 8,104 | 223 | 464 |
| Crawford | 7,786 | 215 | 445 |
| Presque Isle | 7,548 | 208 | 432 |
| Iron | 6,643 | 183 | 380 |
| Lake | 6,638 | 183 | 380 |
| Mackinac | 6,218 | 171 | 356 |
| Alcona | 5,784 | 159 | 331 |
| Montmorency | 5,294 | 146 | 303 |
| Oscoda | 4,978 | 137 | 285 |
| Schoolcraft | 4,748 | 131 | 272 |
| Alger | 4,517 | 124 | 258 |
| Baraga | 4,396 | 121 | 251 |
| Ontonagon | 3,221 | 89 | 184 |
| Luce | 3,089 | 85 | 177 |
| Keweenaw | 1,173 | 32 | 67 |
(Modeled estimate)Most current public data: Urban Institute / CBO P.L. 119-21 Medicaid work requirements score, March 2026. Current enrollment: ACS 2023 5-year C27007 (means-tested public coverage, county-level estimates). Projected loss range: Urban Institute Michigan projection (171,000–355,000) × county ACS enrollment share. Full methodology → | |||
Related coverage-at-risk analyses
- SNAP Coverage at Risk — county-level exposure to P.L. 119-21 ABAWD provisions (methodology)