Mechanicsville, VIRGINIA — In 100 days, on January 1, new federal work and reporting rules will go into effect for people who receive Medicaid, a government health insurance program for low-income individuals. These changes could put about 10 million Americans at risk of losing their healthcare coverage. States are rushing to prepare for the biggest shift in the Medicaid program in decades. To help, a new $2 million campaign called “Keep Your Care” has launched. It is run by an independent nonprofit and aims to educate both states and Medicaid recipients about the upcoming changes. The campaign was shared exclusively with NBC News. For Melanie and Greg Stephens, who live in a small town near Richmond, Virginia, the new rules are a source of significant worry. On August 31, the family received a letter detailing the new requirements. “When I got the letter about all the changes coming up, I had a panic attack because I was like, ‘Oh my gosh, what does this mean?’” Melanie Stephens said. The Stephens are full-time caregivers for their disabled daughter, Rachel, and are exempt from the 80-hour-per-month work or community service requirement that will apply to most eligible adults. However, they must still prove their exemption every six months. “Our concern is not so much on our part because we are thorough,” Greg Stephens said. “Once it leaves us and goes to a Medicaid worker to process, that’s where we are concerned they’re going to miss a deadline or fall through the cracks, and we have no control over that.” The new work requirements, supported by Republicans, were included in a major law signed by former President Donald Trump. The goal was to reduce what they called wasteful spending in the Medicaid program. However, healthcare advocates argue that these requirements could leave many eligible people without coverage due to the complex administrative procedures they now face. Virginia Health Secretary Marvin Figueroa described the situation as “fighting government for something that you’re entitled to.” He noted that the debate surrounding the law included concerns about people losing coverage, and he expects this to happen widely. Senate Majority Leader John Thune and many Republicans defended the changes, saying they aimed to eliminate waste, fraud, and abuse in Medicaid while ensuring the program remains sustainable for the long term. “And what’s being said out there by the Democrats is totally inaccurate,” Thune said in an interview before the legislation passed. “It doesn’t cut Medicaid … What we’re talking about here is getting rid of waste, fraud, and abuse, strengthening and improving the program for the people who need it the most.” “Keep Your Care” was created by two health care advocacy groups, Caring Across Generations and the Healthcare Education Project, along with the Service Employees International Union. The campaign will focus on states like Georgia, North Carolina, Illinois, Michigan, California, Virginia, and New York, which have expanded Medicaid under the Affordable Care Act. These states are home to millions of people who could lose their coverage under the new rules. The group is helping eligible Americans keep their health insurance and is also influencing how state and local governments implement the new requirements. Their website provides detailed information about the changes, exemptions, and deadlines for each state. Greg Stephens, a former physician, once judged patients who had Medicaid coverage. But after becoming a recipient himself, he now understands the challenges. His daughter, Rachel, 22, has faced increasing health issues since the pandemic and requires 24/7 care. As a result, Greg quit his job last year, just as his wife had done years before. “We spent months calling other insurance companies and agents and trying to find another way, and there was no other way,” Melanie Stephens said. The Medicaid coverage allows the Stephens to care for Rachel at home, which involves administering medications five times a day and feeding her through a tube. Without this coverage, the only alternative would be an institution. “There’s no one that could possibly care for her medically, or emotionally or cognitively,” the Stephens said. “She would have no will to live.” They believe the new rules are an overcorrection that places unnecessary stress on families who need Medicaid to care for their loved ones. “There’s a lot of people that are getting health care through Medicaid expansion, like ourselves, that absolutely need this exclusion to be able to do what we do,” Greg Stephens said.