🌎 Resumen en español · traducción automática
La administración Trump estrechó la definición de quién califica como "médicamente frágil" para eximirse de los nuevos requisitos de trabajo en Medicaid, lo que preocupa a las agencias estatales porque muchos enfermos y discapacitados podrían perder cobertura. Los estados que expandieron Medicaid bajo la Ley de Cuidados Asequibles deben exigir a los adultos inscritos trabajar, estudiar o hacer voluntariado al menos 80 horas mensuales, con excepciones solo para quienes tengan condiciones de salud significativas e impedimentos importantes para trabajar. Las agencias estatales ya enfrentaban dificultades para implementar estos requisitos antes de la fecha límite de enero de 2027, y la nueva orientación federal publicada el 1 de junio complica aún más el proceso.
Traducción y resumen generados por IA a partir del artículo en inglés. Puede contener errores; consulte el texto original.
Dr. Mehmet Oz, administrator of the federal Centers for Medicare & Medicaid Services, speaks at the Department of Health and Human Services in Washington, D.C., in December. CMS last month released guidance on how states should implement new Medicaid work requirements. (Photo by Alex Wong/Getty Images)
State Medicaid agencies are concerned that many sick and disabled enrollees will lose their coverage because the Trump administration is narrowing the definition of who is “medically frail” enough to get an exemption from new work requirements.
Under the tax and spending law President Donald Trump signed a year ago, states that have expanded Medicaid to cover more adults under the Affordable Care Act — 40 states plus the District of Columbia — must mandate that those adults work, go to school or volunteer for at least 80 hours a month.
The so-called One Big Beautiful Bill Act exempts Medicaid recipients who are “medically frail,” with serious illnesses or disabilities. However, on June 1 the Trump administration published interim guidelines for implementing the law that specify that in order to qualify for the “medically frail” designation, a person must have a significant health condition and be significantly impaired in their ability to work.
“This rule helps Americans build skills and independence through work, education, job training, or community service, creating new opportunities for themselves and their families,” said Dr. Mehmet Oz, director for the federal Centers for Medicare & Medicaid Services, in a statement earlier this month announcing the new guidance.
But states had been operating under the assumption that they would use the federal government’s traditional “medically frail” designation, which includes five distinct categories of disabilities and illnesses but does not require Medicaid agencies to determine whether the person can work.
States already were scrambling to set up systems to enforce the new work rules by the January 2027 deadline, according to Jocelyn Guyer, senior managing director at Manatt Health, a consulting firm that advises state Medicaid agencies.
“Now, it’s not enough just to have that diagnosis. You may need to go to your doctor and get a special note,” Guyer said. “So, it’s turned it from a very straightforward protection of people with disabilities and significant health conditions into a paperwork morass, where all of a sudden they have to get their healthcare providers involved in documenting and assessing their capacity to work.”
Earlier this week, 25 Democratic-led states plus the District of Columbia sued the Trump administration over the work requirement, largely on the basis of the changed “medically frail” guidelines.
Several state Medicaid agencies said they’re struggling to understand what they’ll have to do to comply. Even before the “medically frail” change, states were hiring consultants and creating IT systems to verify and track enrollees’ working status, which they never had to do before.
“Most states were working on identifying a number of diagnoses that may be able to meet that definition in hopes that that would align with what the final guidance said,” Melanie Bush, deputy secretary for the North Carolina Medicaid Division of Health Benefits, said. “But the layering in of impaired ability to work — there’s not necessarily a data source that aligns with that.”
Bush said states are focused on figuring out how to prevent eligible people from dropping off the rolls just because of paperwork and logistical challenges. One analysis estimates that five million people could lose coverage from the original work requirements alone. State leaders and consultants worry that figure could rise significantly with the new guidance.
Healthcare providers are worried, too.
“This is not what we’re trained to do. Most of us do not do disability determinations and employability assessments regularly, and even if we do feel comfortable with that role, we don’t have time, we’re not like we’re not paid to do that,” said Dr. Benjamin Sommers, a health economist at the Harvard T.H. Chan School of Public Health.
“Primary care providers, in particular, are already overworked and burning out.”
Still, Medicaid directors have experience in dealing with major shifts within the program, according to Michael Heifetz, a managing director at consulting firm Alvarez & Marsal and a former Medicaid director in Wisconsin. Heifetz said states regularly face major rule changes and tight timeline challenges, and with greater access to advanced technology to help automate some tasks, he’s confident they will be able to mitigate enrollment losses.
Another big help, he said, is that Medicaid enrollees will be allowed to “self-attest” to their eligibility for an exemption through 2027.
“States will work through it, and they will again work with the advocacy community to minimize the impact on beneficiaries,” Heifetz said. “There is still some ambiguity in the rule about how self-attestation will work in 2027, because the rule reads that other sources of information and documentation must still be sought, but in the end, self-attestation will prevail.”
Jennifer Tolbert, an expert on state health policy at health research group KFF, said there are several data sources states might tap to determine a person’s ability to work, such as insurance claims, prescriptions and a person’s use of durable medical equipment.
She cautioned, however, that it will be a challenge to use such data to make thoughtful determinations, especially for people with substance use disorders and mental health issues.
To keep eligible people enrolled, California will use text message alerts, mailed notices, and electronic reminders to make sure recipients meet verification deadlines, according to Anthony Cava, a spokesperson for California Department of Health Care Services. Nevertheless, Cava said, the state is concerned that people, including those with serious illnesses and disabilities, will drop off the rolls “solely due to paperwork barriers.”
Adela Flores-Brennan, Colorado’s Medicaid director, said states could come under fire for making errors.
“We’re also worried about audits,” Flores-Brennan said. “There are new penalties for states, bigger penalties for states related to error rates, and the level of complexity that is being introduced into eligibility right now is making an environment that is ripe for errors because it’s confusing and it’s complex.”
Stateline reporter Shalina Chatlani can be reached at [email protected]
This story was originally produced by Stateline, which is part of States Newsroom, a nonprofit news network which includes Kentucky Lantern, and is supported by grants and a coalition of donors as a 501c(3) public charity.
