US Medicaid work‑requirement rule controversy

In late July 2026 the Centers for Medicare & Medicaid Services issued an interim final rule that makes work reporting a condition for Medicaid eligibility in the ACA expansion. Non‑pregnant adults aged 19‑64 must log 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 projects the rule could strip coverage from roughly 2.3 million people in fiscal year 2027, rising to over 3 million in later years. Several states – Nebraska, Montana and Arkansas – have already begun enforcement, while twenty‑five states and the District of Columbia have filed lawsuits seeking an injunction, with a hearing slated for July 28 in Massachusetts federal court.

The same day, stakeholder reactions surfaced. ME Action warned that the rule could exacerbate stigma and jeopardize coverage for individuals with Myalgic Encephalomyelitis and Long COVID, citing concerns over the narrow definition of medical frailty. Conversely, the policy group Americans for Tax Reform praised the measure, arguing that its medical‑frailty test, expanded community‑engagement options, and reliance on existing SNAP and TANF infrastructure would curb fraud, encourage self‑sufficiency among able‑bodied adults, and protect Medicaid’s overall integrity.