New Medicaid Work Requirements Raise Health Coverage Concerns

On sweltering afternoons, DeAnna Brandon delights in splashing in her backyard kiddie pool with her grandkids. At 48, as a blood cancer survivor, these moments in Rockwell, North Carolina are precious. Yet, she’s anxious about retaining her health coverage with new Medicaid work requirements on the horizon.

Brandon anticipated a medical frailty exemption. However, recent guidance from President Trump’s administration has cast doubt. The Centers for Medicare and Medicaid Services (CMS) interim rule suggests her symptoms—extreme exhaustion and memory issues from treatment—must “significantly impair” her ability to meet new work mandates.

If Brandon’s case is rejected, she risks losing coverage and crucial chemotherapy for her multiple myeloma remission. “Working is not possible for me,” she disclosed in an interview. Despite being driven to persevere through fatigue previously, Brandon finds explaining her inability to do so now challenging.

Health experts warn that this latest guidance deviates from state expectations and jeopardizes insurance for many. Adrianna McIntyre, a Harvard University public health professor, points out the resulting paperwork burden, especially for the sickest Medicaid patients, might cause unnecessary loss of coverage.

“This will mean more paperwork for Medicaid patients—specifically for the sickest Medicaid patients,” McIntyre said. “That’s going to push in the direction of more people needlessly losing coverage.”

Part of broader policy changes, the new Medicaid rules arise from a significant healthcare policy law passed in 2025. Affected individuals, aged 19 to 64, must demonstrate 80 monthly working or community service hours, or half-time school attendance. Exemptions apply to the medically frail or those in addiction treatment.

Confusing states, CMS’s redefinition of medical frailty now requires significant impairment proof to make exemptions. Accepted exemptions hinge on substantiating this claim by 2028, potentially with doctor notes—a requirement some providers may resist.

Brandon, previously unsuccessful at claiming disability benefits due to active cancer treatment, laments the anticipated difficulties for patients proving their impairment. “It’s not easy—one may need consultations with several doctors,” she shared, noting that enduring this while ill is a considerable energy drain.

States struggle with implementing the rule, aiming to use Medicaid claims data for automatic exemptions. Yet, CMS underlines data won’t categorically exclude anyone based solely on diagnosis, creating further confusion for state officials like Kinda Serafi from Manatt Health consulting.

“States are going to be asked to make a determination using information that doesn’t exist in their systems,” Serafi stated.

High costs for new implementations loom; federal and state budgets will bear over $1 billion in expenses. Some states, like Nebraska, advance work requirements, yet must adapt systems to align with new CMS rules.

Republicans argue that work requirements will safeguard Medicaid for genuine needs. Dr. Mehmet Oz from CMS notes that the aim is to prevent freeloading through these measures, aiming at booking beneficiaries towards productivity.

Conversely, Democrats decry these mandates as attacks on healthcare access for vulnerable populations. Individuals like Mids Meinberg, a New Jersey resident with chronic health conditions, feel misrepresented in political narratives portraying them unfavorably.

Brandon emphasizes the value she brings to nurturing her grandchildren, underscoring that contributions aren’t limited to traditional working roles. “We’re valuable, and we can still contribute to our communities,” she affirms.