Dr. Mehmet Oz, administrator of the federal Centers for Medicare and Medicaid Services, speaks at the Department of Health and Human Services in Washington, D.C., in December. This week, CMS released guidance on how states should implement new Medicaid work requirements. (Photo: Alex Wong/Getty Images)
Federal government released new conductivity this week on how states should implement Medicaid work requirements that will impact health insurance for millions of Americans.
The new interim rules, issued by the federal Centers for Medicare and Medicaid Services, are intended to give states more detail on how they should verify the work status of about 20 million adults enrolled in Medicaid, the publicly funded health insurance program for low-income people.
The new details emerge as states look ahead to the Jan. 1, 2027 deadline for implementing new work requirements, and have asked federal authorities for more clarity on how to implement them.
“States are being asked to implement a complex federal mandate without clear rules, without enough time and at the risk of eligible people losing health care coverage due to documentation problems and system failures,” Oregon Gov. Tina Kotek, a Democrat, said last week statement.
Kotek led a six-state coalition of Democratic governors asking last week, the Trump administration slowed the implementation of new work requirements, calling the schedule unworkable.
Congress included new work requirements in last year’s so-called One Big Beautiful Act. Under this measure, states that expanded Medicaid eligibility to more adults under the Affordable Care Act: 40 states and the District of Columbia and another two that have partially expanded — will have to require those adults to prove they work, go to school or serve their communities at least 80 hours a month to receive Medicaid.
The rules released this week aim to clarify key parts of the new law, including exemptions for people considered “medically frail,” how to contact Medicaid beneficiaries and methods for verifying Medicaid eligibility.
“This rule helps Americans build skills and independence through work, education, job training or community service, creating new opportunities for themselves and their families,” Dr. Mehmet Oz, director of the Centers for Medicare and Medicaid Services, said in a statement announcing the new guidelines.
But critics of the work requirement point to evidence that it exempts people from Medicaid who would otherwise be eligible, without significantly increasing the share of working adults.
For example, Arkansas tried to impose work requirements for Medicaid beneficiaries during Trump’s first term in 2018. Less than a year later, a federal judge halted the policy 18,000 adults have already lost coverage and reported having trouble paying off medical debt, delaying health care, and delaying taking medications due to cost. Research later showed that the job requirements of Arkansas did not escalate employment. Data shows that most adults on Medicaid are under age 65 they are already working.
Supporters say the new requirements are pliant. They say the feds have created a broad category of “medically tender“people who are exempt from work requirements, and allow states to allow people to self-certify once that they are exempt from work requirements before documentation is required.
The new job requirements will include, among others: about 20 million people eligible for Medicaid through expansion, according to estimates from research organization KFF. Expansion enrollees represent approximately 30% of all Medicaid enrollees.
A recent analysis by the Urban Institute shows that 3-7 million people could lose their insurance due to new job requirements.
Stateline reporter Anna Claire Vollers can be reached at: avollers@stateline.org.
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