Trump Administration Unveils New Medicaid Work Requirements

The Centers for Medicare & Medicaid Services (CMS) has announced significant changes to Medicaid eligibility requirements that will require recipients to engage in at least 80 hours of work or community service each month. This update follows the enactment of the Working Families Tax Cut (WFTC) legislation and represents one of the most substantial shifts in Medicaid eligibility and financing in over a decade.

CMS stated that the reforms aim to connect able-bodied, working-age adults with employment and community engagement opportunities, enhance the integrity of the program, and ensure the long-term sustainability of Medicaid and the Children’s Health Insurance Program (CHIP). States must implement these new requirements by January 1, 2027, or sooner.

Under the new guidelines, all Medicaid enrollees, unless exempt, will need to complete and report 80 hours of work each month. This work can include a traditional job, community service, volunteering, or educational pursuits. The administration has introduced these requirements to combat fraudulent claims, foster personal responsibility, and incentivize job growth.

Some states had already adopted similar requirements before the passage of the WFTC, but the new rules will now apply to all states, making compliance mandatory.

Details of the New Requirements

The updated work requirements aim to align Medicaid with other public assistance programs, such as the Supplemental Nutrition Assistance Program (SNAP) and Temporary Assistance for Needy Families (TANF). CMS has advised states to ensure that they connect beneficiaries to work and community opportunities while balancing flexibility with operational costs.

CMS emphasizes the importance of aligning these new policies with existing statutory and regulatory guidelines. This approach is designed to minimize operational expenses and streamline processes for states. The agency also highlighted the need for states to ensure that community engagement verifications are easily auditable, thus protecting taxpayer interests.

To assist in implementing these changes, CMS has allocated a total of $200 million for fiscal year 2026 to help states develop the necessary systems. States will have the discretion to decide whether recipients need to demonstrate their community engagement over one, two, or three consecutive months before January 1, 2027.

Reactions to the Changes

Health and Human Services Secretary Robert F. Kennedy, Jr. expressed his support for the changes, stating, “I am very pleased that CMS is providing clear direction to states using breakthrough Medicaid community engagement tools that restore the dignity of work and lift people out of poverty, while supporting the sustainability of Medicaid for the most vulnerable.”

CMS Administrator Dr. Mehmet Oz also voiced his approval, asserting, “For far too long, too many Americans who are able to work have been left isolated and discouraged by programs that don’t encourage their potential. These reforms send a clear message: you have agency, your contributions matter, and we will support you on the path to purpose and prosperity.”

As the implementation date approaches, the impact of these changes on Medicaid enrollees remains a topic of discussion among policymakers and advocates. Critics argue that the new requirements could create barriers that may disenfranchise some individuals due to the administrative burden of proving eligibility.

The upcoming adjustments to Medicaid eligibility are poised to reshape the landscape of public health assistance in the United States, with potential implications for millions of Americans relying on these critical services. The future of Medicaid will depend on how states adapt to these new requirements and the effectiveness of the reforms in achieving their intended goals.