New Medicaid Work Rules Will Require 80 Hours a Month, Sick Americans Must Prove They Qualify for Exemptions

The Trump administration has released new guidance detailing how states will implement Medicaid work requirements, a major policy change that will require many adult beneficiaries to work, volunteer, attend school or participate in job training for at least 80 hours per month to maintain health coverage.

The guidance, issued by the Centers for Medicare & Medicaid Services (CMS), provides the first detailed roadmap for a requirement approved as part of last year's tax and spending legislation. The rules are scheduled to take effect on Jan. 1, 2027.

CMS Administrator Dr. Mehmet Oz defended the policy during a White House briefing, arguing that Medicaid should prioritize the nation's most vulnerable populations while encouraging able-bodied adults to transition into the workforce and eventually obtain employer-sponsored health insurance.

Under the new rules, adults subject to the requirement must document at least 80 hours per month of work or qualifying activities. Those activities can include employment, job training programs, education or certain volunteer service. States will be required to verify compliance at least every six months, although they may conduct reviews more frequently.

"If you're sitting at home, which is true for the millions of people who are able-bodied on Medicaid, on average, you're spending 6.1 hours watching television just hanging around," Oz said when explaining who will be affected, according to the Trump Administration.

One of the most controversial aspects of the guidance involves medical exemptions.

Individuals who claim they are too ill to work will have to demonstrate that they qualify for an exemption. CMS officials said states will first review existing health records and medical claims data to determine whether a person meets the definition of being medically frail or otherwise unable to comply with the requirement. Beginning in 2028, documentation standards will become stricter and beneficiaries seeking exemptions may need to provide additional evidence supporting their claims.

Pregnant women, people receiving postpartum care, individuals with disabilities and those officially classified as medically frail will remain exempt. People who already satisfy federal work requirements through the Supplemental Nutrition Assistance Program (SNAP) will also be exempt from the Medicaid requirement.

Potential consequences

The policy could affect millions of Americans enrolled in Medicaid.

Supporters argue the requirement will reduce dependence on government assistance, increase labor force participation and help preserve Medicaid resources for low-income children, seniors, disabled individuals and others with significant medical needs. Dr. Oz has argued that able-bodied adults currently enrolled in Medicaid are placing pressure on a program originally intended for the most vulnerable populations.

Critics, however, warn that the biggest consequence may not be unemployment but paperwork.

Health policy experts point to previous state experiments with work requirements that resulted in eligible recipients losing coverage because they failed to complete reporting requirements, missed deadlines or struggled with verification systems. Democratic lawmakers argue that many Medicaid recipients already work but could still lose coverage because of administrative hurdles.

The Congressional Budget Office previously estimated that Medicaid work requirements approved by congressional Republicans could result in approximately 4.8 million people losing health insurance coverage over time, although administration officials dispute assumptions behind those projections.

In top of that, states must now build or expand verification systems, coordinate data sharing between agencies and process exemption requests. CMS has announced $200 million in grants to help states implement the new requirements.

For now, beneficiaries will have some flexibility. Until 2028, enrollees will generally be allowed to self-attest that they meet the work requirements before more stringent documentation rules take effect. Federal officials have warned, however, that false statements could trigger enforcement actions.

The guidance sets the stage for what is likely to become one of the most closely watched healthcare policy battles of Trump's second term, with supporters framing the changes as a return to work-focused welfare policy and opponents warning that millions could lose access to medical care despite remaining eligible for the program.