Trump Administration Imposes Medicaid Work Reporting Rules, Forcing Oregon To Rework IT Systems

The Trump administration issued an interim final rule on Medicaid work reporting requirements that sets a June 1 protocol for implementing work requirements for Medicaid recipients, including a directive for who qualifies for an exemption from an 80-hour work mandate due to medical frailty.

“States are voicing frustration with the Trump administration’s new protocol for implementing Medicaid work requirements, calling the federal decisions a shift that imposes significant burdens on their programs”

Bloomberg Law News

The rule is tied to the One Big Beautiful Bill Act and is scheduled to take effect in January 2027, with states facing a deadline to implement the work mandate months ahead of that date.

Bloomberg Law News

Bloomberg Law reports that the nearly 400-page Trump directive is expected to exclude more people from coverage and increase burdens on states, and it cites the Oregon Health Authority saying the “rules differ significantly from the guidance that we had been operating under” and may require the agency to “rework and reprogram” IT systems.

In a separate account, PhillyVoice says the rules finalized Monday require most Americans ages 19 to 64 to establish proof they are working at least 80 hours a month to receive Medicaid, and it quotes the American College of Physicians warning that “Community engagement requirements create a tangle of red tape” that diverts resources from patient care.

Advocates for people with serious illnesses argue the interim final rule narrows the “medical frailty exemption” so that a diagnosis alone is not enough, and STAT says the condition or disease must be actively interfering with a person’s ability to work.

STAT reports that advocates foresee newly diagnosed cancer patients losing Medicaid if they do not fill out paperwork correctly, and it quotes Adrianna McIntyre saying, “It takes states literally months — usually years — to make the types of changes to their systems.”

CNN

In a separate critique, CNN says the CMS rule takes a harder line on defining which low-income adult enrollees are eligible for an exemption for those who are “medically frail,” requiring that the condition “significantly impair their ability to comply with the work mandate.”

CNN also quotes Jennifer Hoque of the American Cancer Society Cancer Action Network warning that an individual in active cancer treatment will have to overcome “what, for some, will be insurmountable obstacles to get or maintain coverage,” and it adds that CMS’ interpretation “clearly conflicts” with the One Big Beautiful Bill Act, according to a group of 48 patient organizations.

Multiple outlets describe states scrambling to adjust eligibility and exemption processes after the interim final rule, with KFF Health News saying the rollout will force states to scrap months of preparation and rework systems less than seven months before states must start enforcing the requirement.

“Trump’s Medicaid Work Rules Force States To Scrap Plans and Rework Systems The Trump administration’s rollout of a federal mandate that millions of Americans on Medicaid must work or risk losing health benefits will force states to scrap months of preparation, according to advocates for Medicaid enrollees and consultants advising states”

KFF Health News

KFF Health News reports that the rules issued June 1 dictate how states should check whether Medicaid enrollees are following the rules and how people can claim an exemption, and it says the “medical frailty” exemption allows a person to claim they have a health condition that prevents them from working at least 80 hours a month.

The same KFF Health News account quotes Kinda Serafi saying the “administration has actually taken what we know to be a tough situation and has just made it even worse,” and it adds that states will have to “undo work that they did,” citing Daniel Meuse of Princeton University’s State Health and Value Strategies program.

Meanwhile, Bloomberg Law reports that the Oregon Health Authority warned the rule may cause it to “rework and reprogram” IT systems and set back its progress, while PhillyVoice says Pennsylvania Department of Human Services Secretary Val Arkoosh testified that staff must be retrained and that the lack of clarity about the definition of “medically frail” will require hiring about 250 more staffers and additional education for 6,000 others.