States set to implement a controversial work requirement for some Medicaid recipients in January may delay enforcement of the rule for six months, the Centers for Medicare and Medicaid Services announced Friday.
The rule, which was set out last year in President Donald Trump’s sweeping One Big Beautiful Bill policy legislation, will require Medicaid expansion recipients to spend at least 80 hours a month working, training for a job, in school or volunteering to qualify for benefits, with exemptions for certain illnesses and disabilities.
The Trump administration has said the rule will prevent fraud and encourage employment, but it has drawn controversy as critics have warned it could take scores of recipients off coverage.
States and health advocacy organizations have sued the Department of Health and Human Services over the rule, arguing that it will harm medically frail patients and saddle states and health care providers with the additional burden of documenting whether people qualify for work requirements.
Friday’s update appeared to acknowledge that states might need more time to smoothly implement the work requirements.
The announcement from CMS encouraged states to use an optional six month “hold harmless” period to “learn from the early months of implementation to identify and address workforce training needs and improve the beneficiary experience.”
“States have made real progress, and they’ve been clear with us about what it takes to get this right for beneficiaries — at scale and for the long term,” Deputy Administrator and Director of the Center for Medicaid and CHIP Services Dan Brillman said in a statement.
During the six month period, states should continue to assess whether Medicaid recipients and applicants satisfy work requirements but not deny applications or disenroll otherwise eligible recipients, according to CMS.
Opponents of the work requirement rule welcomed the announcement.
“This is a recognition that states simply are unprepared and unable to implement these new rules without causing massive coverage losses,” Alison Barkoff, a professor of health law and policy at George Washington University who filed amicus briefs in two lawsuits challenging the work requirements, wrote to The Washington Post.
“It’s imperative that states opt to delay terminations and denials until proper systems are in place to protect individuals’ lifesaving coverage,” Lisa Lacasse, president of the American Cancer Society Cancer Action Network, which has also supported a lawsuit against the requirements, said in a statement. “Continuing with the current work requirement implementation timeline will mean more suffering and death from cancer.”
The changes to Medicaid under the One Big Beautiful Bill Act, including work requirements and a more frequent six month redetermination period, could lead to between 5 and 10 million fewer enrollments by 2028, according to an estimate by Urban Institute, a think tank.
Before Friday’s update, most states were set to begin enforcing the work requirement at the start of the new year. Some states, including Nebraska and Montana, have implemented the work requirement early. Over 1,000 Nebraskans have either lost or were denied coverage since the state implemented the rule in May, according to the nonprofit Nebraska Appleseed.
CMS did not immediately respond to an inquiry on whether the optional six month pause would apply to states that have already begun enforcing the work requirement.
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