The Medicaid cuts Republicans in Congress imposed in the One Big Beautiful Bill Act (OBBBA) forced strict work requirements on adults in need of medical coverage, forcing millions to lose their healthcare. But it didn’t go far enough for the Trump administration, which this week is trying to make it even harder for people with disabilities or chronic conditions to get or stay on Medicaid. The Centers for Medicare and Medicaid Services (CMS) issued an interim final rule changing the definition of “medically frail” on Monday that will increase the likelihood that people with cancer, disabilities, and other chronic conditions will lose or be unable to qualify for Medicaid coverage. Onerous paperwork requirements previously implemented in other states like Arkansas have proven ineffective in achieving their professed goal of boosting employment while extremely effective in kicking people off their health coverage. The administration is gutting healthcare for the most vulnerable people to pay for tax cuts for the wealthy and vanity projects for an egomaniacal president. The idea that there are millions of “freeloaders” who are “sitting at home playing video games and collecting a check,” is absurd. Medicaid provides free or low-cost healthcare, not checks and lives of leisure. And most people on Medicaid are already working. It’s yet another example of Trump and his allies in Congress prioritizing themselves above the working-class people they swore to fight for.
KEY FACTS AND DATA
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Trump’s new Medicaid rules will hurt people struggling with cancer, disability, and chronic disease.
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The OBBBA forces people in the Medicaid expansion group (people living in states that expanded Medicaid under the ACA) to prove they work 80 hours per month, with few exceptions, like pregnant women, or those with a disability or dependent child. Those people still have to submit paperwork on a regular basis to prove they are exempt from working to continue getting care. [Health Care Dive]
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One exception in the law is for the “medically frail” which was not defined in the legislation, but was commonly understood to be people whose chronic condition or disease would worsen if they were forced to work. The administration chose to be harsher and define medical frailty as having a condition that would “significantly impair” their ability to work, or, being too sick to work. People with cancer, or HIV/AIDS, or end-stage renal disease wouldn’t be exempt from working, unless they were too sick to report work hours. [New York Times]
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If a cancer patient can’t prove their inability to work, they would not be exempt from the work requirements, and thus in danger of losing their Medicaid coverage at a time in their lives when medical coverage is a matter of life and death. “With this decision, CMS is piling on additional documentation and logistical challenges for individuals who need to enroll or maintain their coverage and clinicians who are already overburdened. Cancer will not wait while Medicaid offices sift through paperwork,” said Lisa Lacasse, president of the American Cancer Society Cancer Action Network. [The Hill]
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“People living with HIV have a lifelong serious and complex medical condition and have special medical needs — they cannot stay healthy without continuous access to lifesaving HIV treatment. Any gap will put them at risk of serious health consequences.” – Carl Schmid, executive director of the HIV+Hepatitis Policy Institute [HIV+HEP Policy Institute]
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Experts say CMS’s rule of what constitutes a disability that would keep someone from working is alarmingly narrow. Instead of using the definition of disability in the Americans with Disabilities Act, they have instead created their own definition that will take healthcare away from disabled Americans. [Disability Scoop]
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“Despite Congress’ promises that people with disabilities will be exempt from these requirements, not all people with disabilities are exempt. Disabled people will lose access to Medicaid.” – Maria Town, president and CEO of the American Association of People with Disabilities
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The American people don’t want Medicaid cuts.
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Americans see government contracts, not benefits programs, as the worst source of fraud. [Navigator]
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Voters in every congressional district have opposed cuts to Medicaid. “Nationwide, 50% of voters want Congress to increase funding for Medicaid, 38% want funding to be kept as it is, and 8% want to cut funding.” [Data for Progress]
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Federal Medicaid work requirements hit states hard.
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Last month, Nebraska became the first state to implement the OBBBA’s early implementation mechanism for Medicaid work requirements. The state says they’ve had no complaints from new applicants. But maybe that’s because the phone line’s not working: “Molly Mayhew, 35, lives in Lincoln and is in the process of getting on disability while also navigating the new Medicaid work requirements. ‘During May, I probably called about half a dozen times. A few times I just had to give up and ask for a callback after waiting on the line for a half hour — that’s my limit,’ Mayhew said.” [KOLN Nebraska]
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“‘If I lose my Medicaid, I’m gonna lose access to my doctor’s offices, to my prescriptions, things that are basically keeping me going,’ Mayhew said. ‘That’s been incredibly stressful. If I can’t have the things to function at a very basic level, then I’m a potato.’”
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While the Trump administration says it imposes cuts like this to save money, states are having to spend tens of millions to build the systems, train staff, and do the nearly impossible work of trying to figure out “which low-income residents are working, volunteering, caregiving, or studying enough hours to keep their Medicaid coverage,” or who’s sick enough to be exempt. The law apportions some money to help states with implementation but it’s not nearly enough, especially given these costs will be annual. [Politico]
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For next year only, states can let people self-report if they qualify for an exemption, but after that, states have to verify claims and demand documentation from people who need Medicaid. [The Hill]
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Medicaid cuts don’t even do what their advocates say they do.
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Evidence has shown that work requirements don’t actually increase employment. What it does is take coverage away from people who need it. The rushed nature of the changes in the OBBBA, absence of solid guidance from the federal government, and limited capacity mean that even more people will lose coverage from these cuts than you’d expect. [CBPP]
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“Most adults covered by Medicaid are already working, caregiving, or would not be subject to this policy due to illness or disability. Research shows us that instituting work requirements will not meaningfully increase employment.” – Jan Carney, MD, MPH, president of the American College of Physicians [American College of Physicians]
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About a third of U.S. direct-care workers like home health workers depend on Medicaid for their own healthcare. The nature of home health work means inconsistent schedules and an inherent difficulty in logging hours to prove compliance with the 80-hour work requirements in the new Medicaid rules. Home health workers are more liable to have gaps in employment thanks to a client being hospitalized or dying. [Home Health Care News]
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CALL TO ACTION
Share this post of a doctor’s reaction to watching CMS administrator Dr. Oz fumble his way through a justification for Medicaid work requirements.