States are beginning to implement new work requirements for Medicaid eligibility, which may lead to enrollees losing their coverage if they do not report at least 80 hours of work, school, or volunteering each month. This new phase has started, with Nebraska being the first state to enforce these requirements ahead of the national deadline set for January 1, 2028. Reports indicate that approximately 200 individuals in Nebraska may lose their coverage this week due to non-compliance with reporting requirements.
Concerns have been raised by patients, providers, and advocates regarding the adequacy of exemptions for those with disabilities or illnesses. A survey by the American Cancer Society revealed that 90% of cancer patients and survivors have missed work or school due to their condition, and many find it challenging to submit the necessary paperwork to prove their eligibility for exemptions.
Healthcare providers are also expressing anxiety over the new rules, which place the burden of determining medical exemptions on clinicians. The American College of Physicians has highlighted that physicians are not trained to assess vocational capabilities and has requested that the Centers for Medicare and Medicaid Services (CMS) allow for broader categorical exclusions based on existing claims data.
In a related development, a federal judge in Massachusetts has declined to halt the implementation of these new rules, despite a lawsuit from several states challenging the restrictions on medical frailty exemptions. The ongoing changes in Medicaid are occurring alongside other pressures, including funding freezes and tighter state budgets, which are contributing to a complex environment for Medicaid programs and their enrollees.