GOP lawmakers and administration officials have described the policy as a way to combat waste, fraud, and abuse in the Medicaid program, but Democrats and many health policy experts say millions of people will lose coverage without a meaningful increase in the number of people employed.
The rules require people to prove they are working, volunteering, attending school or participating in a qualifying job-training program for 80 hours per month to keep their coverage.
There are several categories of exemptions, but the one that’s worrying experts and patient advocates the most is a stricter definition of “medically frail.”
States will have some discretion to decide which medical conditions qualify, but the new rules implicitly link the definition of medical frailty to a person’s ability to work.
“If your condition significantly impairs your ability to engage in work and the requirements, then you are likely not subject to the work requirements,” said Dan Brillman, the Trump administration’s Medicaid director.
States had anticipated the rule would specify medical frailty broadly as someone whose condition would worsen if they did not have access to care. But the rules were much stricter.
“We do not believe it is reasonable to categorically consider conditions as serious or complex without factoring in criteria such as the severity of the condition,” CMS wrote in the rule.
“The mantra we kept coming back to was that we’re forgiving, but we’re not foolish,” CMS Administrator Mehmet Oz told reporters on a call Monday. “If we make it so easy to defraud [Medicaid] — that everyone feels that they’re fooled for not defrauding it — that’s not so good,” he said.
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