Additional Coverage:
- Medicaid recipients forced under new rule ordering them to prove they’re too ill to work (themirror.com)
Last week, the Trump administration unveiled a new Medicaid rule that will take effect on January 1, requiring recipients classified as medically frail to regularly demonstrate that they remain unable to work. Under this policy, individuals previously exempted from work requirements due to serious health conditions must now prove their ongoing inability to engage in work or similar activities every six months.
Dr. Ben Pezeshki, a primary care physician and medical director at Sequoia Quality Health in Los Angeles, expressed concern over the rule’s impact, particularly on patients with cancer.
He emphasized that imposing work requirements on these vulnerable populations places them in a difficult position. “Sometimes they can’t keep a job because of their illness, and if they lose their job and their coverage, then Stage 1 becomes Stage 4,” Pezeshki explained.
While recipients will be allowed to self-attest to their medical frailty in 2024, from 2028 onward, they must provide official documentation biannually to maintain their Medicaid coverage. The Centers for Medicare and Medicaid Services (CMS) will allow individual states to determine which “serious or complex health conditions” qualify for exemptions, with some states already moving swiftly to comply. For example, Nebraska has released a nearly 300-page list of qualifying conditions as it began enforcing the rule early on May 1.
The administration’s guidance goes beyond what Congress approved last year by adding a stricter secondary criterion: a person’s health must prevent them from working, volunteering, caregiving, or studying for at least 80 hours per month.
Patient advocates have raised alarms over the new requirements, warning that they place an undue burden on both patients and their healthcare providers. Jennifer Hoque, associate principal on policy for the American Cancer Society Cancer Action Network, noted the challenges in verifying whether a person is truly “unable to work,” highlighting the lack of clear data sources for such assessments.
Several advocacy organizations are preparing to challenge the rule, urging CMS to allow exemptions for seriously ill individuals without the need for repeated proof of medical frailty.
In the meantime, the lack of detailed guidance has left state officials, doctors, and patient advocates anticipating that individual physicians will bear the responsibility of evaluating whether Medicaid enrollees qualify for medical exemptions based on their ability to work.