CMS Medicaid Work Requirement Set to Cut Coverage for Millions

A new Centers for Medicare & Medicaid Services (CMS) rule makes work reporting a condition for Medicaid eligibility. The interim final rule, effective Friday, requires non‑pregnant adults aged 19‑64 in the ACA Medicaid expansion to document 80 hours of employment, self‑employment, community service, job training, or half‑time education each month, or earn income equal to 80 times the federal minimum wage.

CMS estimates the rule will remove roughly 2.3 million people from coverage in fiscal year 2027, rising to 3.1‑3.3 million in subsequent years—about 15 % of the expansion population. States must begin notifying members by August 31, with compliance starting January 1, 2027. Nebraska, Montana and Arkansas have already begun enforcement.

Twenty‑five states and the District of Columbia have sued CMS, seeking a preliminary injunction. A hearing is scheduled for July 28 in the U.S. District Court for the District of Massachusetts, but the rule remains in force. CMS Administrator Dr. Mehmet Oz defended the policy as a “guardrail,” saying that those who can work should be required to do so.