DeAnna Brandon, a 48-year-old resident of Rockwell, North Carolina, cherishes her time with her grandkids and dogs. As a blood cancer survivor, Brandon fears that new Medicaid work requirements may put her health coverage at risk. She had hoped to qualify for a medical frailty exemption, but recent guidance from the administration of former President Donald Trump has cast doubt on this possibility. According to the interim final rule from the Centers for Medicare and Medicaid Services (CMS), being ill with symptoms like extreme exhaustion and memory issues might not suffice to bypass the new mandates. Brandon would need to demonstrate that these symptoms ‘significantly impair’ her ability to work, volunteer, or attend school. Without meeting these requirements, she might lose access to her maintenance chemotherapy, which keeps her multiple myeloma in remission.
Brandon expressed the challenges she faces in meeting work expectations due to her condition. ‘I was always a push-through-it person — you know, ‘Oh, you’re tired. Push through,’’ she said. ‘It’s hard to explain to people you can’t push through it.’
Concerns from Health Analysts
Experts warn that the latest guidance from the Trump administration differs from what states anticipated. This change could result in more Americans losing their health insurance. Harvard University’s public health professor, Adrianna McIntyre, highlighted that the new rules might lead to more paperwork, especially for the sickest Medicaid patients. ‘This will mean more paperwork for Medicaid patients — specifically for the sickest Medicaid patients,’ McIntyre said. ‘That is going to push in the direction of more people needlessly losing coverage.’
Impact on Medicaid Recipients
The restrictions, criticized by Democrats, stem from a policy change introduced in 2025. These rules affect those covered through Medicaid expansion, where recipients aged 19 to 64 must either engage in work or community service for at least 80 hours monthly or attend school half-time. Exemptions exist for those deemed medically frail or in certain treatment programs.
Last week’s CMS announcement revised the definition of ‘medically frail.’ It now demands proof that a person’s condition ‘significantly impairs’ their ability to work or attend school. The ambiguity over what documentation can effectively prove such impairment remains a concern. Advocates fear that the necessary paperwork could become a burden for those already battling illnesses.
Brandon’s previous attempts to qualify for disability benefits during cancer treatment were unsuccessful, increasing her anxiety about navigating future requirements. ‘It’s not that easy — you may have to go through four doctors,’ she noted. ‘If you’re already battling an illness like this, you don’t have the physical or the mental or the emotional energy to do that all the time.’
State-Level Confusion
States prepared to use Medicaid and other data to automatically provide exemptions for eligible enrollees. CMS Administrator Dr. Mehmet Oz supports using data to aid recipients without requiring direct interactions. However, the lack of clarity on how to implement these changes leaves state officials uncertain. ‘States are going to be asked to make a determination using information that doesn’t exist in their systems,’ Kinda Serafi from Manatt Health commented.
Nebraska’s head start on implementing work requirements with diagnostic codes reflects potential challenges. The state may need to reassess its system to align with new federal guidelines. Sarah Maresh from Nebraska Appleseed expressed concerns about doctors’ willingness to provide necessary certifications.
Compliance with the new policies, starting January 1, involves substantial costs. A $200 million federal fund aids states, but the overall expense exceeds $1 billion, funded by both federal and state taxes.
Mixed Political Reactions
While Democrats criticize these requirements as detrimental to healthcare access, Republicans argue they are essential to preserve Medicaid for those truly in need. Oz cited a report claiming that many Medicaid recipients spend significant time on leisure activities. ‘Work requirements are going to turn this around, we hope,’ he advised.
Mids Meinberg, a freelance writer in New Jersey with chronic health issues, suggests this characterization overlooks the reality for many. ‘There are many people with disabilities who are “too disabled to work but not disabled enough for the state to think they can’t work,”’ he explained.
Brandon seeks understanding from policymakers, asserting her engagement with her grandchildren as a meaningful contribution. ‘I’m pouring into my grandchildren,’ she shared. ‘We’re valuable, and we can still contribute to our communities even if it’s not working.’