Medicaid Work Requirements Set to Take Effect January 1
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New federal rules requiring many Medicaid recipients to prove they are working, in school, or volunteering will take effect on January 1. The requirements, part of a broader budget law, apply to most states that expanded Medicaid under the Affordable Care Act and are estimated to lead to millions losing coverage.
Facts First
- New work requirements for Medicaid take effect January 1 for adults aged 19 to 64 in most expansion states.
- Recipients must prove 80 hours per month of work, school, or volunteering or prove they qualify for an exemption.
- The Congressional Budget Office (CBO) estimates 5 million people will lose coverage due to the requirements.
- States are responsible for implementing the rules and determining eligibility for exemptions.
- Public comments on the interim final rule are open until July before it is finalized.
What Happened
The Trump administration released new guidance and nearly 400-page interim final rules this week, detailing work requirements for Medicaid recipients. The rules, passed as part of a budget bill signed last July, require states to implement the requirements by January 1. They apply to more than 40 states that expanded Medicaid under the Affordable Care Act (ACA). Under the rules, adults aged 19 to 64 must periodically prove they are working, attending school, or volunteering at least 80 hours per month, or prove they are exempt.
Why this Matters to You
If you or someone you know receives Medicaid in a state that expanded coverage under the ACA, you may need to start documenting work or volunteer hours to keep benefits. An estimated 5 million people could lose coverage under these rules, which may increase the number of uninsured. For those with health conditions, proving an exemption may require demonstrating that the ailment actively interferes with the ability to work, rather than relying on an automatic list of diagnoses.
What's Next
States must now set up systems to verify compliance and determine exemptions. The HIV + Hepatitis Policy Institute plans to file comments on the final rule and lobby states for exemptions. The interim final rule is open for public comment until July, after which it will be finalized. The full impact on coverage and state administration will likely become clearer after implementation begins.