Trump Administration Unleashes Medicaid Work Requirements, Exemptions for Select Groups

Pregnant women, parents of young children, veterans with disabilities, and other select groups will dodge the new Medicaid work requirements, according to the Trump administration's announcement.

The Centers for Medicare & Medicaid Services released guidance detailing how states should implement these work rules, fulfilling a June 1 deadline tied to President Donald Trump’s “big, beautiful bill.”

Starting January 1, many adults on Medicaid must clock in at least 80 hours a month through work, school, or volunteer activities to maintain their coverage.

Exemptions also apply to individuals deemed “medically frail” or those with severe conditions like cancer or substance use disorder. Notably absent is any exemption for the homeless.

States hold the power to define which medical conditions warrant exemptions. Nebraska, which rolled out Medicaid work requirements this year, compiled a nearly 300-page list of medical codes and technical jargon to classify medically frail individuals.

During the initial year, applicants can simply attest to qualifying for an exemption on their Medicaid applications or renewal forms without needing documentation, federal health officials confirmed on a call.

From 2028 onward, states must verify these exemptions. This temporary leniency aims to give states time to establish systems capable of confirming exemptions through claims data and other records.

However, allowing self-reporting without proof raises concerns about potential fraudulent claims.

“We’re forgiving, but we’re not foolish,” stated Dr. Mehmet Oz, the CMS administrator. “We are appropriately going after problem areas and doing it in a way that’s compassionate and forgiving, but we don’t want to be false.”

Larry Levitt, executive vice president for health policy at KFF, a nonpartisan health policy research group, noted that self-declaration for exemptions could prevent many Medicaid enrollees from slipping through the cracks and becoming uninsured.

Projected outcomes indicate that around 5 million individuals may lose their health coverage by 2034 due to these work requirements, primarily driven by bureaucratic red tape rather than job status, according to a KFF report.

“The quick implementation timeline makes it even harder for states to set up adequate systems,” Levitt added.

The Trump administration asserts that this policy will motivate more individuals to seek employment or boost their work hours.

Officials referenced a report from the National Bureau of Economic Research indicating that Americans are working fewer hours than in past decades. They argue that government benefits diminish the drive to pursue jobs.