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Medicaid Work Rule: Chronic Illness Now Requires Proof
8 Jun
Summary
- Medicaid recipients must now prove medical frailty every six months.
- Doctors fear this new rule will cause chronically ill patients to lose coverage.
- States are struggling to implement the stricter federal work requirement test.
New federal regulations mandate that Medicaid recipients claiming medical frailty exemptions from work requirements must now provide proof every six months. This rule, set to take effect on January 1, has alarmed patient advocates and physicians who fear it will disrupt care for chronically ill individuals. The Trump administration introduced a stricter test, requiring proof that a condition prevents working at least 80 hours per month, beyond a diagnosis alone.
States are grappling with how to enforce this new mandate, with concerns rising about the administrative burden on both doctors and patients. Previously, states anticipated using existing diagnosis codes, but the federal guidance demands a more rigorous assessment of an individual's ability to work, a determination doctors feel ill-equipped to make. Advocacy groups are urging CMS to reconsider, warning of potential coverage losses for vulnerable populations.
The work requirements apply to individuals aged 19 to 64 enrolled in Medicaid expansion, covering those up to 138% of the federal poverty level. While exemptions exist for pregnancy or childcare, millions could be impacted. The uncertainty surrounding data utilization and the practical application of the new rules leaves states, clinics, and patients anxious about the upcoming deadline and its potential consequences.
