The Trump administration on Monday published an interim final rule that requires most Medicaid enrollees ages 19 through 64 to work, participate in job training, or perform community service for at least 80 hours per month to maintain their health coverage, implementing a provision from the president’s major tax-and-spending law signed in July. The Centers for Medicare & Medicaid Services issued the rule with immediate effect under an “emergency” designation, and states face a Jan. 1 deadline to implement it. Patient advocacy groups and Democratic lawmakers said the requirement will create paperwork barriers that cause millions of low-income people to lose coverage.
MSI previously reported that similar Medicaid work mandates are already forcing states to spend millions of dollars on new technology to track enrollees’ hours. Related coverage.
CMS said the rule promotes “economic stability, self-sufficiency and independence.” CMS Administrator Mehmet Oz said in a statement that the policy “helps Americans build skills and independence through work, education, job training or community service, creating new opportunities for themselves and their families.”
The requirement applies to most non-elderly, non-disabled adults. Exempted categories include pregnant people and those who have recently given birth, parents and caretakers of children or people with disabilities, individuals deemed medically frail, and American Indians and Alaska Natives, according to a CMS fact sheet.
Democrats who opposed the underlying legislation during congressional debate said the rule will create bureaucratic obstacles that prevent people who depend on the program from keeping their coverage. Sen. Ron Wyden, D-Ore., the ranking member of the Senate Finance Committee, said in a statement that the rule represents “the dark heart of Republican plan to kick millions of working Americans and their children off their health insurance by placing a mountain of paperwork in front of them.”
“When these requirements go into effect at the beginning of next year, it’s going to be a complete train wreck for America, and not just for the Americans caught in the bureaucratic maze Republicans have created: every community will be left with worse healthcare,” Wyden said.
Medical groups raised concerns that the policy will strip coverage from people fighting serious illnesses. Lisa Lacasse, president of the American Cancer Society Cancer Action Network, said in a statement that cancer patients who want to keep working have to navigate an arduous exemption process.
“Cancer patients who can still work — and many want to, for example, when they are well enough to work in between chemo rounds — will have to choose between losing their Medicaid coverage, working the required 80 hours per month or giving up working altogether to qualify for an exemption,” Lacasse said.
The advocacy group Protect Our Care also condemned the policy. President Brad Woodhouse said in a statement that Republicans are “weaponizing government bureaucracy against the American People” by leveraging complexity to drive enrollment down.
“They are betting that if they make the process confusing and exhausting enough, millions of people will fall through the cracks and lose the care they depend on to survive,” Woodhouse said. “Hospitals will suffer, providers will be pushed further to the brink and families across the country will pay the price while Republicans once again put wealthy donors and corporate greed ahead of the health and well-being of everyday Americans.”
Medicaid is a joint federal-state program that provides health coverage for low-income individuals and families. The work requirement was included in the so-called “One Big Beautiful Bill,” the tax-cut and spending package Congress passed and Trump signed earlier this year.