WASHINGTON — The Centers for Medicare & Medicaid Services released guidance on June 1 explaining how states should carry out Medicaid work requirements that take effect January 1, 2025. Beginning that date, many adults on Medicaid will need to work, attend school, or volunteer for at least 80 hours a month to keep their coverage.
Pregnant women, parents of young children, veterans with disabilities, and people deemed “medically frail” or who have conditions that significantly limit their ability to work, such as cancer or substance use disorder, will be exempt from the requirement. The guidance does not include an exemption for people who are homeless. States will have discretion to determine which medical conditions qualify for exemptions.
During the first year, people will be allowed to attest on their Medicaid applications or renewal forms that they qualify for an exemption rather than provide documentation. Beginning in 2028, states will be expected to verify exemptions. States will also be required to evaluate Medicaid enrollees’ eligibility every six months instead of annually.
CMS Administrator Mehmet Oz said, “We’re forgiving, but we’re not foolish. 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.” The Trump administration says the policy will encourage more people to find jobs or increase their work hours. Officials cited a 2024 report from the National Bureau of Economic Research finding that Americans are working fewer hours than in previous decades.
A division of the U.S. Department of Health and Human Services published a research brief contending that Medicaid work requirements may reduce poverty by 1.6 million to 2.9 million people. Initial estimates projected the requirements would reduce federal Medicaid spending by $326 billion and result in 5.3 million people losing coverage.
A KFF report projected that about 5 million people could lose health coverage by 2034 due to paperwork and administrative hurdles rather than job status. Larry Levitt, executive vice president for health policy at KFF, said, “Allowing people to self-declare exemptions for one year means fewer Medicaid enrollees will fall through the cracks and end up uninsured.”