5 takeaways on Trump's divisive Medicaid work requirements |
5 takeaways on Trump’s divisive Medicaid work requirements
A new rule explaining how states need to implement Medicaid work requirements may make it much harder for low-income sick people to maintain health coverage next year.
The long-anticipated rule issued Monday is meant to guide 42 states and the District of Columbia on carrying out the work rules laid out in the One Big Beautiful Bill Act. GOP lawmakers and administration officials have described the policy as a way to combat waste, fraud and abuse in the Medicaid program.
The work requirements are set to take effect in January. Beneficiaries who are part of the Medicaid expansion population must work or volunteer at least 80 hours per month, attend school at least part time or participate in job training.
Alternatively, they must prove they qualify for certain exemptions, like caring for a child 13 years or younger or a parent with a disability.
Here are five key takeaways:
Extremely narrow ‘medically frail’ carve-out
The law included a series of exceptions for certain vulnerable populations, including a carve-out for people who are “medically frail.” But there was no clear definition of what that meant.
States will have some discretion to decide which medical conditions qualify, but the new rules implicitly link the definition of medical frailty to a person’s ability to work.
“If your condition significantly impairs your ability to engage in work and the requirements, then you are likely not subject to the work requirements,” said Dan Brillman, the Trump administration’s Medicaid director.
The words “significantly impair” are not included in the law itself.
“The exemption ensures that work expectations are directed towards those who can participate while protecting those who cannot,” Brillman said.
States had anticipated the rule would specify medical frailty as someone whose condition would worsen if they did not have access to care, said Kinda Serafi, a Medicaid expert at Manatt Health. But the rule was much........