Looming Medicaid Cuts Could End in Disaster. The Trump Administration Just Paused Them for Six Months.

States will not be forced to implement new Medicaid work requirements until mid-2027, the administration announced Friday. The new rules, which were set to kick in on January 1st, mandate that many Medicaid recipients fill out burdensome new paperwork about their employment, while “medically frail” Medicaid patients prove yearly they are unable to work full-time, even if they have already been diagnosed with a debilitating condition and were previously enrolled in the federally-funded health insurance for low-income people.

For the next six months, states “will not deny [Medicaid] applications or disenroll otherwise eligible individuals solely for failure to meet the requirement,” the Centers for Medicare and Medicaid Services announced.

After this six-month “hold harmless period” runs out, states will have to require able-bodied Medicaid recipients under 64 to prove at least 80 hours a month of work or other qualifying activities to avoid being disenrolled from coverage. They’ll generally have to do this by uploading paystubs, income tax returns, timesheets or academic transcripts to their state Medicaid portal, or sending them through the mail, though the requirements will vary by state.

Democratic officials nationwide have said the new restrictions will be harmful to patients in need as they’re faced with new bureaucratic challenges, and onerous for states to implement.

The new Medicaid work requirements were passed last year as part of President Donald Trump’s “One Big Beautiful Bill” (OBBBA), but were intentionally scheduled not to go into effect until after this month’s midterm elections. The bill grants tax breaks to the nation’s wealthiest people while cutting almost a trillion dollars from Medicaid’s budget over the next decade. 

In May of this year, researchers with Human Rights Watch and Oxfam America wrote that 10 million people will likely lose Medicaid coverage due to the various hurdles involved in work requirements. In June, officials in 25 states sued the federal government to block the work requirements, which Democratic officials argued “punish those who cannot fend for themselves.”

Senator Ron Wyden (D-Ore.) and Congressman Frank Pallone (D-NJ.) released a joint statement Friday calling this six-month pause a partial victory. “The Trump-Vance administration finally admitted what Democrats have said from the very beginning: Republicans’ chaotic maze of red tape requirements jeopardizes the health care of millions of Americans,” Wyden and Pallone said. “This disenrollment delay is a small step in the right direction, but it does not avert the disaster ahead. As the incoming chairs of the committees responsible for Medicaid, we are preparing to lead a relentless fight to preserve Medicaid coverage and care for every eligible person. In the meantime, we urge every state to take up this option and protect the Americans that count on them for access to lifesaving health care.”

Some Republican-led states have opted to start Medicaid work requirements ahead of schedule. But officials in those states are already receiving pushback. On May 1st, Nebraska became the first state to implement the more stringent rules requirements. A group of over 50 people gathered at a meeting of the state’s Medicaid Advisory Board last Thursday to share the problems they’ve already had with the rollout. Some of the attendees had spent hours on the phone with the state Department of Health and Human Services trying to figure out how the work-requirement phase-in would impact them or their loved ones—and, according to the Nebraska Examiner’s reporting, they received contradictory answers.

Amanda Gershon, who spoke at the meeting, said the new paperwork for Medicaid participants is too complex for the average person, the Examiner reported. Gershon worked in the healthcare system for 12 years and said she still doesn’t understand how to fill hers out.

“I went to college, got A’s, and this is confusing,” Gershon said. “How is anyone with a developmental disability supposed to do this?”

Though the six-month reprieve buys states time, it doesn’t get rid of the new Medicaid requirements. Some Democratic leaders entering Congress this January, like Congresswoman-elect Annie Andrews of South Carolina, say they plan to make unwinding the Medicaid cuts a priority.

 “This is what’s going to happen: If we kick this many people, millions of Americans, off of their health insurance, that doesn’t stop them from getting sick or injured,” Andrews said in an interview last year. Instead of getting outpatient care, they’ll wait at home until their conditions become dire. Then they will “show up at the one place that is legally required to offer them care: the emergency room.”

Around the country, hospitals are already bracing for this chain of events: a decrease in revenue from Medicaid coverage, combined with an uptick in uninsured patients who can’t pay, could threaten the financial viability of hospitals with large Medicaid populations. Some safety-net hospitals, like Roseland Community Hospital in Chicago, have already filed for bankruptcy in part because of looming Medicaid cuts.