Federal Medicaid Work Requirement Could Strip Coverage From Millions of Sick Americans

Millions of Americans with chronic illness or disability could lose their Medicaid coverage under a new federal rule that takes a harder line on who qualifies for a health-based exemption from an upcoming work requirement.

Starting in January, most states will require Medicaid enrollees to prove they are working, volunteering, or in school in order to keep their coverage. The Centers for Medicare and Medicaid Services issued a new rule clarifying that having a medical condition alone will not be enough to qualify for an exemption. Enrollees must also show that their condition significantly limits their ability to meet the work mandate.

Patient advocacy groups say that distinction matters enormously. Many people living with serious illnesses, including cancer, diabetes, or heart disease, may not be completely unable to work, but still face real barriers to holding consistent employment. Under the new standard, those people may no longer qualify for an exemption, putting their coverage at risk.

Advocacy organizations have warned the stricter interpretation will put people's lives at risk by cutting off access to medication, doctor visits, and other care that Medicaid currently funds for low-income Americans.

The rule applies broadly, though the on-the-ground impact will depend on how individual states implement and enforce the exemption process beginning this January.