Trump Administration Delays Medicaid Work Requirements by Six Months, Giving States Until July
Trump Administration Delays Medicaid Work Requirements by Six Months, Giving States Until July
WASHINGTON — The Trump administration will give states six more months before they must remove people from Medicaid for failing to meet new work requirements, the Centers for Medicare and Medicaid Services said Friday, easing a January 1 deadline that states warned they were not ready to meet.
Under an optional six-month “hold harmless” transition period, states will not have to deny coverage or end enrollment for people who do not meet the work rules until July 1, 2027. The requirements themselves still take effect on January 1, and states must still check whether enrollees and applicants are working, studying, volunteering, or qualify for an exemption — but no one who is otherwise eligible can lose coverage solely for missing the work threshold during the transition.
What the delay actually means
The move, announced in a letter to state Medicaid directors on Friday, gives state social service departments more time to make sure the complicated changes are ready before there are consequences. CMS said states are making progress but still face implementation challenges.
Dan Brillman, the deputy administrator who oversees Medicaid at CMS, acknowledged the significant burden states faced in building out new and expensive software systems to track the employment of enrollees. States that are ready to enforce the rules can still do so from January; states that are not ready will not face federal penalties until July.
“I think these extra six months are going to give states the ability to respond to the change, and there will be fewer people that lose their coverage due to administrative failures” resulting from states’ inability to prepare, Kathy Hempstead, a senior policy officer for the Robert Wood Johnson Foundation, told The Associated Press. She added that it is not clear which states will choose to use the additional time.
Kate McEvoy, executive director of the National Association of Medicaid Directors, said state Medicaid leaders “appreciate the additional flexibility that CMS is providing.”
The rules at the center of the fight
The work requirements were enacted in the summer of 2025 as part of the One Big Beautiful Bill Act (H.R. 1), the sweeping domestic policy law President Donald Trump signed last year — the same law that also tightened food assistance for millions of low-income Americans. In the 40 states that expanded Medicaid under the Affordable Care Act, most working-age adults ages 19 to 64 without dependent children must show at least 80 hours a month of work, volunteering, or enrollment in an education program at least half-time.
People over 64, those caring for children under 14, and people deemed medically frail are exempt. Critics say most enrollees covered by the mandate are already working, and that people are more likely to lose coverage because of the paperwork needed to prove it than because they failed to work. The federal government is pushing states to use data from other government departments to verify whether beneficiaries are working, as a way to reduce the burden on people to show proof.
The Congressional Budget Office estimated that the work requirements alone could leave 5.3 million additional people uninsured by 2034.
Nebraska’s early warning
A few states launched the work requirements early, and the first results showed how easily paperwork can cost people coverage. Nebraska, the first state to start, began enforcing the rules on May 1.
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Preliminary data presented to the state’s Medicaid Advisory Committee showed that more than 9 in 10 people subject to the work requirement and due to have their benefits renewed in July and August qualified. But 533 people were denied continuing coverage. For most of them, it was over paperwork: they did not show that they were working or were exempt. Of those denied, 43 lost coverage because they did not meet the new requirement. Similarly, most new Medicaid applicants denied coverage from May through August did not get it because they did not provide information to verify whether they were complying.
“There are likely people who are still eligible for coverage who lost it,” said Amy Behnke, the CEO of the Health Care Center Association of Nebraska.
A court ruling and a letter from Congress
The delay also follows a recent loss in court over a key element of the work requirement. A federal judge in Boston issued a mixed ruling in Massachusetts v. Oz, a case brought by 25 states and the District of Columbia, rejecting the federal government’s definition of medical frailty and finding that states did not have adequate time or resources to overhaul their eligibility systems.
This week, Democratic Senator Ron Wyden of Oregon and Representative Frank Pallone Jr. of New Jersey wrote to CMS Administrator Dr. Mehmet Oz, asking him to use his discretion to give states more time. Their letter cited the Boston ruling and warned that the implementation issue “may not be definitively resolved for months, creating untenable uncertainty for states.”
Why this matters
The decision could also give some breathing room to Congress to consider changes to the requirement. Democrats who are taking control of both chambers in January after their sweeping election victories last week have said they want to roll back the requirements — a position sharpened during the record 43-day government shutdown that ended this week. The American Cancer Society Cancer Action Network welcomed the delay but urged Congress to act quickly to delay work requirements in all states for two years, warning that cancer patients could otherwise lose coverage in the midst of treatment.
The six-month delay is a reprieve, not a repeal. The work requirements remain the law, and enforcement arrives on July 1, 2027, whether states are ready or not.
Frequently asked questions
When do the Medicaid work requirements take effect?
The requirements take effect on January 1, 2027, but states that take the optional transition period will not have to deny or end coverage over them until July 1, 2027. States must still check whether enrollees meet the rules or qualify for an exemption starting in January.
Who has to meet the work requirements?
In the 40 states that expanded Medicaid, most adults ages 19 to 64 without dependent children must document at least 80 hours a month of work, volunteering, or school at least half-time. People over 64, those caring for children under 14, and people deemed medically frail are exempt.
Will anyone lose Medicaid coverage before July?
During the hold-harmless period, no one who is otherwise eligible can lose coverage or be denied coverage solely because they failed to meet the work requirement. States that are ready, however, may still enforce the rules from January if they choose not to take the transition period.
Sources: Associated Press (via AmeriLedger); Bloomberg Law; STAT; The New York Times; American Cancer Society Cancer Action Network
