NAMI/Ipsos Poll: Most Americans Unfamiliar With and Concerned by New Community Engagement Requirements That Threaten Medicaid Coverage

News provided by

National Alliance on Mental Illness (NAMI)

Jul 29, 2026, 06:00 ET

Poll finds 79% of Americans support allowing people with mental illness to keep their Medicaid coverage.

ARLINGTON, Va., July 29, 2026 /PRNewswire/ -- A new NAMI/Ipsos poll finds that most Americans oppose Medicaid coverage loss for people with mental illness under upcoming Medicaid community engagement requirements. Troublingly, 80% of Americans are unfamiliar with these requirements, which could leave many people unprepared when the requirements take effect in January 2027.

The new requirements could put millions of Americans, including many people with disabilities and mental illness, at risk of losing access to lifesaving care. After learning about community engagement requirements, Americans expressed sharing that worry; nearly two-thirds (65%) of adults are concerned about people losing their Medicaid coverage with these requirements.

"This poll tells us two important things," said Hannah Wesolowski, chief advocacy officer at the National Alliance on Mental Illness (NAMI). "Most Americans don't know these new requirements are coming, but once they understand what's at stake, they overwhelmingly support protecting Medicaid coverage for people with mental illness. As the Centers for Medicare and Medicaid Services (CMS) finalizes a new rule around community engagement, it must ensure that people do not lose access to lifesaving mental health care because of burdensome administrative barriers."

Americans are largely unfamiliar with new community engagement requirements.
While most U.S. adults (80%) are unfamiliar with Medicaid community engagement requirements, more than a third (37%) have never even heard of them. When presented with basic true/false statements about Medicaid community engagement requirements, including when they go into effect and who is exempt, Americans showed low knowledge: correct identification peaked at 27%, and "don't know" responses exceeded 50% across every item.

Most want to ensure people with mental illness keep their Medicaid coverage.
While people are unfamiliar with these requirements, they do not want to see the negative impacts that could happen to people with mental illness as a result of this rule. Large majorities of Americans support protecting people with disabilities, including mental illness, from losing their Medicaid coverage (81%), as well as allowing people with mental illness who are on Medicaid to keep their coverage (79%).

For some people with mental illness, their ability to work varies month to month, but the rule requires more than "disabling mental condition" to be exempt from these requirements. People also must prove that their condition "significantly impairs" their ability to work. This means that people with mental illness may have to prove that their condition is significantly impairing their ability to work at exactly the wrong time — when their condition worsens. The public strongly opposes this: 77% of Americans disagree that people with mental illness should be denied medical care/Medicaid because they are unable to work.

People who are covered or know someone covered by Medicaid are especially concerned about the impact of these requirements.
Among the half of Americans who said they have used Medicaid or know someone who has, concerns about the community engagement requirements are high. Two-thirds (67%) said they don't know what they'll do to pay for health care if they or someone they know loses Medicaid coverage, and nearly half (49%) said they or someone they know will have to skip mental health care, including medications, without Medicaid coverage. Additionally, 59% worry about how these community engagement requirements will impact the health care available in their community.

These concerns also extend beyond health care. Two in five (42%) say it will be harder to keep a job if they lose Medicaid coverage — which runs counter to the purported goals of the community engagement requirements.

NAMI member survey underscores widespread concern

In addition to this public opinion polling with Ipsos, NAMI conducted a survey* of their membership on the same points. While not directly comparable due to different methodologies, people connected to the mental health community who opted to take the survey expressed overwhelming concern (97%) that people will lose their Medicaid coverage as a result of community engagement requirements. Learn more about the NAMI survey findings at nami.org/medicaid.

The findings are especially timely as CMS is accepting public comments through July 31 on an interim final rule to implement the Medicaid community engagement requirements, as required by H.R. 1, signed into law last year. The CMS rules go further than the law, which could result in significant Medicaid coverage losses for people with mental illness.

"The message is clear: Americans want people with mental illness to keep their Medicaid coverage," said Wesolowski. "Access to lifesaving mental health care strengthens individuals, families, and communities. Today's poll raises new alarms about the lack of awareness among the public that this is coming — and the concern over what will happen. CMS needs to protect access to lifesaving care."

NAMI will continue advocating to protect Medicaid and protect mental health. NAMI is encouraging CMS to protect people with mental illness; advocates can also do so by submitting their own comments about the impact of these proposed rules.

Learn more about today's NAMI/Ipsos poll in the research deck and topline.

This NAMI/Ipsos poll was conducted July 10 – 12, 2026, by Ipsos using the probability-based KnowledgePanel®. This poll is based on a nationally representative probability sample of 2,038 general population adults age 18 or older. The survey has a margin of error of ± 2.2 percentage points. Learn more about the poll methodology.

*Separately from the above poll, NAMI conducted a voluntary survey through NAMI's general email list, open July 21-26, 2026. 2,614 individuals responded to the survey. Findings are not representative of all NAMI Alliance or mental health community members, and findings reflect the opinion of the 2,614 people who took the survey.

The National Alliance on Mental Illness is the nation's largest grassroots mental health organization, dedicated to improving the lives of individuals and families affected by mental illness.