Groundhog Day Medicaid Healthcare
“Trump’s New Medicaid Rule ‘Designed to Ensure People Lose Healthcare,’ Critics Warn”
Jake Johnson
The Trump administration on Monday unveiled a rule that is expected to push millions of low-income people off Medicaid by imposing complex bureaucratic barriers in the form of work reporting requirements, which have proven disastrous at the state level.
The rule, released by the Centers for Medicare and Medicaid Services (CMS), marks a key step toward enacting the Republican budget reconciliation package that President Donald Trump signed into law last summer. That measure included around $900 billion in cuts to Medicaid, with new work requirements projected to account for nearly $330 billion of that total.
The new rule will dictate how states must implement the budget law’s Medicaid work mandates and who is exempt from the requirements. States are already spending tens of millions of dollars hiring new staff and upgrading technology in preparation for the mandates taking effect next year.
Broadly, the Trump-GOP law requires adults without disabilities between the ages of 19 and 64 to demonstrate at least 80 hours of work, community service, or other “qualifying activities” per month to keep their Medicaid coverage.
Exemptions to the work reporting requirements include people who are pregnant, caregivers to children under the age of 14, or “medically frail.” The CMS rule defines the latter category as those with “physical or behavioral health conditions that significantly impair their ability to consistently work or participate in other community engagement activities.”
Advocates warned that the rule will force many sick people off coverage. The rule states that people with HIV/AIDS, end-stage renal disease, and cancer would not necessarily be exempt from the work reporting requirements.
According to The New York Times, “states had expected that people with certain serious diagnoses would qualify for the exception, and they had been developing ways to match applications with existing medical records to identify most such people automatically.”
The Times: “Nebraska’s Medicaid program, which began enforcing a work requirement last month, developed a list of exempted conditions that is nearly 300 pages long. The state will now need to adjust.”
Anthony Wright, executive director of Families USA, said Monday that “far from protecting the vulnerable, this guidance significantly raises the barrier for demonstrating medical frailty, meaning many patients in the middle of treatment will have the new hassle of proving their condition, over and over, with any mistake or gap being penalized by the loss of their healthcare and coverage.”
AB: Or what I would call Groundhog Day Medicaid. Each time you prove who you are, your medical needs, and your income. Make it so difficult, that they make mistakes or give up.
“Through this rule,” said Wright, “CMS is requiring duplicative documentation and prohibiting states from taking full advantage of consumer-friendly tools like self-attestation.”
During the first year of the work reporting requirements, which are set to take effect nationwide in January 2027, people will be allowed to attest in Medicaid applications that they meet one of the exemptions, according to administration officials.
“Beginning in 2028, states will be expected to verify the exemptions,” NBC News reported. “The temporary flexibility, the officials said, is intended to give states time to build systems that can verify exemptions using claims data and other records.”
The advocacy group Protect Our Care warned that the new rule “creates a labyrinth of paperwork, reporting mandates, and rigid eligibility rules designed to ensure people lose healthcare, even when they should qualify to keep it.”
“Instead of lowering costs or making care more accessible, Republicans are weaponizing government bureaucracy against the American people,” said Brad Woodhouse, the president of Protect Our Care. “They are betting that if they make the process confusing and exhausting enough, millions of people will fall through the cracks and lose the care they depend on to survive. Hospitals will suffer, providers will be pushed further to the brink, and families across the country will pay the price while Republicans once again put wealthy donors and corporate greed ahead of the health and well-being of everyday Americans.”
The nonpartisan Congressional Budget Office has projected that, over the next decade, the Trump-GOP work reporting requirements will push nearly 3 million people off Medicaid.
Sen. Ron Wyden (D-Ore.), the top Democrat on the Senate Finance Committee, said in a statement that the CMS rule “is the dark heart of the Republican plan to kick millions of working Americans and their children off their health insurance by placing a mountain of paperwork in front of them.”
“These barriers are designed to prevent Americans from getting affordable healthcare, while providing a profit bonanza for the corporate consultants who get paid millions to build bureaucratic booby traps,” Wyden added. “The Republican plan for healthcare is to kick people when they are down, making sick people sicker and hard times even harder. When these requirements go into effect at the beginning of next year, it’s going to be a complete train wreck for America, and not just for the Americans caught in the bureaucratic maze Republicans have created: Every community will be left with worse healthcare.”
I thought I recall reading here – possibly in a link to an AB post – that for an Arkansas work requirement the biggest share of errors by a lot were with recognizing that the actual work requirement was met, not so much with otherwise qualifying exceptions. The state leveraged some other programs’ data and that was very effective in reducing errors within the first few quarters of the program. Essentially the program didn’t have many errors by the 1 year mark. There still was a lively debate whether or not it was net useful. I also recall concern expressed about older, but pre-Medicare, individuals – often women – who were living in areas of minimal job opportunities but didn’t want to move at 59 to Atlanta (or wherever) to work a low paid job until Medicare but weren’t caregivers and felt it made no sense to “learn to code” or similar. They wanted to stay home in their eastern Colorado (or similar) small town with their familiar lives and remaining friends. That was a powerful story, but unsure just how numerous such cases truly will be.