Challenges and Concerns Over New Medicaid Work Requirements

On warm days, DeAnna Brandon enjoys playing in a kiddie pool with her grandchildren and dogs. These moments are precious to her, a 48-year-old cancer survivor in Rockwell, North Carolina. However, she fears her Medicaid coverage may be at risk due to new work requirements starting next year. Brandon expected a medical frailty exemption, but recent guidance from the Trump administration may complicate her situation.

The interim rule by the Centers for Medicare and Medicaid Services (CMS) clarifies that exhaustion and memory issues may not qualify for exemption from the work mandates. Brandon, who depends on bi-monthly chemotherapy to keep her cancer in remission, must prove her symptoms significantly hinder her ability to meet work requirements.

I’ve always pushed through challenges, Brandon explained in an interview. However, the effort to meet these demands is beyond her capacity. She expressed concerns that she could lose vital health coverage if unable to prove her case.

Health experts warn the new requirements might cause more Medicaid users to lose coverage. Adrianna McIntyre from Harvard University called it a substantial burden for the sickest beneficiaries.

The law, originating from Trump’s tax and policy reforms in 2025, mandates that adults aged 19 to 64 must work or fulfill equivalent commitments for at least 80 hours monthly. Exceptions exist for medically frail individuals, but a recent CMS revision now requires proof that their condition significantly impairs their abilities.

Brandon shared her past struggle to prove disability during her cancer treatment, emphasizing the overwhelming documentation involved. States planned to leverage claims data to identify exemptions, a process CMS supported. However, state officials expressed confusion, as existing data doesn’t adequately demonstrate incapacity to work, leading to uncertainty on meeting CMS expectations.

Nebraska implemented early Medicaid work requirements using diagnostic codes to identify medical frailty. However, adjustments might be needed due to the new rule, raising concerns for healthcare providers already dealing with extensive paperwork.

Nebraska Appleseed’s Sarah Maresh noted the potential strain on doctors reluctant to treat Medicaid patients due to increased administrative tasks. Preparing for the changes by January 1 involves significant costs. Reports estimate an additional $1 billion in expenses, shared by federal and state funding. Moreover, CMS has partnered with tech firms to reduce associated costs.

The rule faced criticism from Democrats as an attack on healthcare for low-income Americans, but supporters argue it’s a necessary step to eliminate misuse and prioritize resources for those most in need. CMS Administrator Dr. Mehmet Oz highlighted a report suggesting that many Medicaid beneficiaries spend six hours a day on leisure activities. He believes work requirements can revitalize these individuals.

Critics, including Medicaid enrollees, argue the requirement overlooks their realities. Mids Meinberg, a freelance writer with chronic conditions, maintains a meaningful career but can’t meet the monthly work hours. He asserts that many, like himself, fall between recognized disability and work capacity.

Brandon stresses the value of those not traditionally employed, contributing in different capacities. She hopes the government can recognize this distinction.