Trump Adds Work Requirements To Medicaid, Resolving Long-Standing Concern That Sick Americans Could Receive Care Without First Proving They Were Too Sick To Work

WASHINGTON. The Centers for Medicare and Medicaid Services this week issued the long-awaited rules implementing the One Big Beautiful Bill's Medicaid work requirements, finally closing what officials described as a dangerous loophole in which Americans too poor to afford insurance and too sick to work were nonetheless permitted to receive medical care.

Under the new rules, adults enrolled in Medicaid must document 80 hours per month of work, job training, or community service in order to keep their coverage. Enrollees who are seriously ill may apply for an exemption, provided they can first furnish paperwork proving they are too sick to work, a determination that under the previous system was made by the simple fact of being sick.

"We are only asking able-bodied adults to contribute," said one official familiar with the rule, referring to a population that the Congressional Budget Office expects to shrink not because its members found jobs but because they will fail to complete the monthly filings correctly. Roughly 10 to 17 million Americans are projected to lose coverage under the law's Medicaid provisions, a number the administration has characterized as a reduction in waste.

The rule arrives less than seven months before states must begin enforcing it, requiring all fifty to scrap the eligibility systems they had been building and start over with ones capable of tracking, verifying, and rejecting the hours of millions of recipients. Several states that had spent the past year preparing for an earlier version of the policy were instructed to begin again. The cost of constructing the machinery to remove people from Medicaid will be borne by the same taxpayers whose Medicaid is being removed.

Administration officials noted that the savings generated by the requirements will help offset the cost of extending the 2017 tax cuts, the largest benefits of which flow to households earning more than one million dollars a year, a group that has not been asked to document anything.

At press time, a cancer patient in Missouri had successfully demonstrated that she was too sick to work by missing the filing deadline while hospitalized, and had been removed from the program accordingly.