The Trump administration will allow states to delay enforcement of new rules requiring low-income adults to work in order to receive Medicaid coverage, according to a letter it sent on Friday to state Medicaid directors.
The announcement, which followed a recent loss in court over a key element of the work requirement, represents a major setback for a long-sought Republican reform. It comes less than two months before the work requirements were set to begin, on Jan. 1. States can now wait until July before ending coverage for people who do not meet the work requirement, the letter said.
In the letter, Dan Brillman, who oversees Medicaid at the Centers for Medicare and Medicaid Services, acknowledged the significant burden states faced in building out new, expensive software systems to track the employment of enrollees. Hospitals have prepared massive education campaigns to help patients navigate the additional paperwork.
“We have heard directly from states about their implementation timelines, impediments to successful launches at scale,” Mr. Brillman wrote in the letter.
He added that the federal government still expected states in January to begin checking whether Medicaid enrollees are working. But for six months, they will not be required to cancel coverage for people who fail to comply, Mr. Brillman said.
The work requirement was enacted in the summer of 2025 as part of Republicans’ major tax and domestic policy legislation. It requires Medicaid enrollees without disabilities or young children to prove they worked, volunteered or attended school at least 80 hours a month in order to qualify for the program or continue enrollment in it.
The new requirement was expected to lead to substantial reductions in Medicaid coverage, disqualifying not only beneficiaries without jobs but also many who worked but were tripped up by documentation challenges. The Congressional Budget Office estimated that the policy would result in five million more Americans becoming uninsured over the next few years.
Democratic lawmakers fought the policy last year. Representative Hakeem Jeffries of New York, the minority leader who is poised to become speaker when Democrats take over control of the House in January, has announced plans to vote on reversing the work requirement and other Medicaid cuts within the first 100 hours of the next Congress.
In court, 25 states and the District of Columbia had already won a six-month reprieve from some aspects of enforcing the work requirement. A federal judge in Massachusetts found that the Trump administration’s rules for defining who is too “medically frail” to comply with work requirements were stricter than the law allowed.
The January start date is specified in the text of the 2025 tax law. At a conference with state Medicaid officials last summer, where many expressed concerns about the timetable, Trump administration officials warned that no extensions would be coming.
“We know it’s going to be really hard for you to meet the deadline,” said Sara Vitolo, the deputy director for Medicaid. “It’s going to be hard for us. The expectation is going to be that we hit it. And that’s coming from the White House.”
The law also allows states to begin enforcing a work requirement early, and Nebraska and Montana have already begun their programs. In Nebraska, state officials estimate that more than 1,700 people have already been denied or lost Medicaid coverage due to the policy.
Christopher Rowland contributed reporting.
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