Kidney Dialysis Centers NAICS 621492

May 8, 2026 - States May Struggle To Implement New Medicaid Work Requirements

• States need more time to comply with new Medicaid requirements, according to a report from the Center on Budget and Policy Priorities think tank. Many Medicaid expansion enrollees must document at least 80 hours per month of work or similar activities, meet an income threshold, or qualify for an exemption to keep coverage under the new requirements. Fewer patients with end-stage kidney disease died within a year of starting dialysis in states that expanded Medicaid coverage in the wake of the Affordable Care Act, according to Brown University researchers. States face a tight timeline to comply with complex eligibility, reporting, and verification processes before the requirements take effect on January 1, 2027. The Congressional Budget Office estimates that millions of people could lose coverage not because they fail to meet requirements, but because they struggle to navigate reporting systems or encounter administrative barriers. Without more time and clearer federal guidance, the report argues, states risk deploying aging or overburdened systems that are not fully ready.
• More than one in seven American adults has chronic kidney disease (CKD), and as many as nine in 10 adults with CKD don't know they have it, according to the Centers for Disease Control. If CKD progresses to kidney failure, known as end-stage renal disease, regular dialysis treatments or a kidney transplant will be required to survive. Each day, 360 patients begin dialysis, and roughly 40% of those who rely on dialysis “crash” into it, meaning that they were unaware they had kidney disease when they suddenly became ill and required immediate dialysis services.

• Fewer patients starting dialysis are enrolling in Medicare since the introduction of the Affordable Care Act (ACA) in 2014 and are instead opting for private insurance, according to a study published in in JAMA Health Forum. The ACA expanded access to private insurance by preventing plans from denying coverage because of preexisting conditions, promoting state insurance exchanges, and relaxing special enrollment periods. “Dialysis expenditures for privately insurance patients were at least twice as high as patients with Medicaid who enrolled in Medicare after dialysis initiation and several times higher for patients with Medicaid who did not enroll in Medicare,” the investigators note. “This may lead to unnecessarily high overall societal costs and inequitable access to care for some patients, which ultimately affects payers, patients, and overall consumers (ie, overall consumer health care insurance premiums are not limited to patients with ESKD).”
• Kidney dialysis center industry employment and average wages for nonsupervisory employees increased slightly during the first two months of 2026, according to the US Bureau of Labor Statistics. Kidney dialysis industry sales are forecast to increase at a 5.72% compounded annual rate from 2026 to 2030, faster than the growth of the overall economy, according to Inforum and the Interindustry Economic Research Fund, Inc.