Medicaid's work requirement crunch arrives

As states begin to implement new work rules for Medicaid enrollees, a crunch period has begun in which patients face the risk of losing coverage if they fail to report at least 80 hours a month of work, school or volunteering. Nebraska was the first state to enforce these requirements, with about 200 people set to lose coverage this week due to non-compliance.

Health policy experts warn that as many as 7 million individuals nationwide could lose coverage by 2028 as a result of these work requirements. Patients, providers, and advocates have expressed concerns over the adequacy of disability and illness exemptions, with a recent survey by the American Cancer Society revealing that 90% of cancer patients and survivors had to miss work, school, or volunteering due to their illness.

Three-quarters of these patients found it difficult to submit paperwork for exemptions during treatment. The American College of Physicians has urged CMS to authorize broader medical exemption categories using existing claims data and to give states more flexibility in determining medical exemptions. However, health care providers are concerned that the rules for determining medical exemptions will place a heavy burden on them, as they are already overburdened with paperwork.

Meanwhile, the Centers for Medicare & Medicaid Services (CMS) remains committed to reviewing all submitted comments before making any necessary changes to the rule. Despite the implementation challenges, other Medicaid enrollees, such as parents of young children and the elderly, remain exempt from the work requirements.