Full Breakdown
Trump Administration Issues Final Rule on Medicaid Work Requirements
6/2/2026, 7:57:28 AM
Overview
CMS issued a final rule requiring Medicaid beneficiaries ages 19-64 to complete at least 80 hours of work, school or community service monthly to retain coverage. The One Big Beautiful Bill Act, signed by President Donald Trump, mandates state implementation by Jan. 1, 2027, with a one-year self-declaration exemption period. CMS Administrator Dr. Mehmet Oz will oversee rollout, while analyst Larry Levitt and state agencies set exemption criteria.
Implementation
The rule exempts pregnant women, parents of children under 13, veterans with disabilities, and medically frail individuals with conditions like cancer or substance-use disorder; homeless people receive no exemption. States may define qualifying diagnoses—Nebraska listed 300 codes—and must verify self-declared exemptions using claims data, with full verification by 2028.
Impact
The Congressional Budget Office and Kaiser Family Foundation estimate about five million Medicaid enrollees could lose coverage over the next decade, mainly due to paperwork and administrative hurdles rather than job status. The National Bureau of Economic Research notes a long-term decline in average American work hours, which the administration cites as justification.
Official Statements
CMS officials say the rule will “encourage more people to find jobs or increase their work hours” and argue benefits “reduce incentives to seek employment.” They call the one-year self-declaration period a safeguard while states build verification systems.
Criticism
Critics note homeless individuals are excluded and self-reporting may invite fraud. Larry Levitt warns that “the quick implementation timeline makes it even harder for states to set up adequate systems,” and KFF predicts losses will stem from administrative complexity, not work eligibility.
Conflicts
Sources differ on the start date: one article cites a Jan. 1 rollout, another a Jan. 1, 2027 deadline. Coverage-loss estimates also vary, with one projecting losses by 2034 and another by the end of the next decade. No data show how many current enrollees qualify for exemptions.
Quotes
- “We’re forgiving, but we’re not foolish.” — Dr. Mehmet Oz, CMS Administrator
- “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.” — Dr. Mehmet Oz, CMS Administrator
- “The quick implementation timeline makes it even harder for states to set up adequate systems.” — Larry Levitt, Executive Vice President, KFF
- “This is our path to prosperity for the American people. It’s a way to preserve our precious Medicaid program for those who benefited from it.” — Dr. Mehmet Oz, CMS Administrator
What's Next
States must file exemption criteria and launch verification systems within a year. CMS will require compliance reports, and several states have signaled legal challenges. The federal government will monitor enrollment trends and may adjust exemptions based on early data.
