The Trump administration will give states six more months before they have to enforce sweeping new Medicaid work requirements, easing fears that millions of lower-income Americans could lose health cover in a rushed rollout.
The Centers for Medicare and Medicaid Services (CMS) said on Friday that states could use an optional “hold harmless” transition period running through 30 June 2027. During that window, states must still check whether Medicaid applicants and beneficiaries are working, studying or volunteering, or qualify for an exemption — but no one who is otherwise eligible can lose or be denied cover solely for failing the requirement.
The requirements, set out in the One Big Beautiful Bill Act signed by President Donald Trump last year, are still due to take effect on 1 January 2027. States that are ready may enforce them from that date; those that are not will face no federal penalty until 1 July. CMS has asked states to request the flexibility in their mitigation plans by 11 December.
Under the rules, many adults enrolled in Medicaid under the programme’s expansion — generally those aged 19 to 65 in the 40 states that expanded the scheme — must work, volunteer or take part in a work programme for at least 80 hours a month, or be enrolled in education at least half-time. Nebraska became the first state to put the requirements into practice in May.
The delay follows warnings from states that they had not been given enough time to build the staffing, training and technology needed to police the rules by January. Dan Brillman, CMS deputy administrator and director of its Center for Medicaid and CHIP Services, said the transition period would give states time to modernise eligibility systems, automate verification and train staff.
The stakes are high. Studies estimate that between five and 10 million people could lose Medicaid cover in 2028 once the requirements are fully enforced, although supporters of the policy say it restores the programme’s focus on work.
The delay is a reprieve rather than a repeal. The requirements remain the law, and enforcement will arrive on 1 July 2027 whether states are ready or not — unless Congress acts. Democrats, who take control of both chambers in January after sweeping midterm wins, have said they want to roll the requirements back. Earlier this week, Senator Ron Wyden and Representative Frank Pallone, the senior Democrats on the Senate Finance and House Energy and Commerce committees, wrote to CMS Administrator Dr Mehmet Oz asking him to delay the work reporting rules and protect eligible beneficiaries from losing cover.
The requirements are also being challenged in court by 25 states and the District of Columbia.
Sources: Associated Press (https://ameriledger.com/article/us-gives-states-another-6-months-before-they-have-to-remove-people-from) and Fierce Healthcare (https://www.fiercehealthcare.com/regulatory/trump-administration-delays-enforcement-medicaid-work-requirements-six-months).
