Chronically Ill People Face Confusion Over New Medicaid Work Rules and 'Medically Frail' Exemption

Healthcare attorney Jennifer Hananoki was quoted in a STAT News article about new Medicaid work requirements, specifically questions surrounding the exemption for medically frail individuals. Under the changes, enacted as part of the One Big Beautiful Bill Act, individuals on Medicaid will need to verify that they work, volunteer or attend school for 80 hours per month to maintain coverage; the medical frailty exemption allows qualifying persons to forgo this obligation, but it remains unclear what conditions qualify and how patients should prove the severity of their disease. Jennifer told STAT News some states had hoped certain illnesses or chronic conditions – "a patient who has terminal cancer, a patient who has advanced end-stage renal disease and is going to a dialysis facility three days a week, those types of scenarios" – would automatically qualify patients for the exemption, but rules from the Centers for Medicare & Medicaid Services (CMS) instead mandate documentation of "functional impairments" that preclude work. Further, the government will allow self-attestation for the first year but require supporting health data beginning in 2028. What the changes ultimately mean for covered individuals remains to be seen as states begin implement the requirements and legal challenges to them progress in court.

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