By Amina Niasse
NEW YORK, June 1 (Reuters) – The U.S. agency that runs the Medicare and Medicaid programs on Monday announced interim guidance on how states should implement new work requirements for Americans enrolled in Medicaid health plans.
The rule announced last year as part of President Donald Trump’s tax cut and spending bill requires 80 hours of work per month to be eligible to receive Medicaid, the health program for low-income Americans.
Eligibility for enrollees must be verified at least every six months or at plan renewals, but states can choose to conduct checks more frequently.
“These folks are crowding out programs that were originally designed for those truly in need,” said Centers for Medicare & Medicaid Services Administrator Mehmet Oz.
Oz said the initiative aims to move able-bodied enrollees to employer-sponsored health plans and “free up critical space in the program for our most vulnerable populations.”
Medicaid is jointly funded by state and federal governments, unlike Medicare for older Americans, which is fully federal. States will receive a combined $200 million in grants to support implementation.
U.S. Representative Frank Pallone, a New Jersey Democrat, said the requirements make it more difficult for Americans to receive care.
“People are already struggling to get by as prices on everyday expenses skyrocket, and now millions of Americans will lose their healthcare not because they’re not working, but simply because they got buried in paperwork,” said Pallone in a statement.
The new requirements go into effect January 1, 2027, but a CMS official said before 2028 Medicaid members can self-attest to having met the requirements.
Members who are pregnant, receiving postpartum care, disabled or deemed to be medically frail are exempt from the work rules. Those who have already met work requirements introduced for receiving food assistance under the Supplemental Nutrition Assistance Program, or SNAP, are also exempt.
Medicaid Director Dan Brillman said the agency aims to conduct real-time verifications by relying on existing electronic data, such as medical claims information.
Beginning in 2028, enrollees will only be able to self-attest once that they have met the new requirements and will have to provide documentation. For those seeking medical exemptions, states must first check health insurance claims history to confirm frailty, a CMS official said.
“We are serious about the consequences of dishonesty in self-attestation,” said Oz. “We will be speaking with different enforcement bodies to make sure that folks know that is not a joke.”
(Reporting by Amina Niasse in New York; Editing by Bill Berkrot)
