The Trump administration will let states delay enforcing new Medicaid work requirements until July 1, 2027, while still requiring checks to begin January 1.
The Trump administration on Friday announced a six-month delay in enforcing Medicaid work requirements, according to a letter sent to state Medicaid directors.
The requirement still technically starts on Jan. 1, but under new guidance from the Centers for Medicare & Medicaid Services, states that choose not to enforce it won’t be held accountable until at least July 1.
CMS called the six-month window a “hold harmless” period, and the delay is optional. States that choose to take advantage of this period will still start checking on Jan. 1 whether Medicaid enrollees are working, volunteering or in school or whether they qualify for an exemption. But until July, no one in those states will lose coverage for failing to meet the requirements.
“States have made real progress, and they’ve been clear with us about what it takes to get this right for beneficiaries — at scale and for the long term,” said Dan Brillman, who oversees Medicaid at CMS.
The work requirement was enacted in the summer of 2025 as part of Republicans’ major tax and domestic policy legislation. It requires Medicaid enrollees without disabilities or young children to prove they worked, volunteered or attended school at least 80 hours a month in order to qualify for the program or continue enrollment in it.
The Congressional Budget Office estimated the work requirements alone would leave 5.3 million more people uninsured by 2034 and would save the federal government $317 billion, part of nearly $1 trillion in Medicaid cuts in the law.
In Nebraska, which launched the work requirements May 1, over 1,000 people have lost coverage or been denied benefits because of the new rules, according to state figures through August.
A federal judge last month blocked the Trump administration from enforcing a portion of the requirement related to medically frail people, saying it could lead some to wrongly lose coverage. In October, a Massachusetts judge sided with the states and rejected the Trump administration's definition of “medical frailty” for critical exemptions.
The delay comes as states face operational challenges in building systems to track enrollee employment. Hospitals have prepared education campaigns to help patients navigate additional paperwork, and state Medicaid agencies have warned that the accelerated IT and administrative build required by January 1, 2027, is putting pressure on local welfare offices and safety-net hospital operating margins.
Sources
This article was drafted with AI assistance and checked against the sources above. Company claims are reported as claims. Cover image is AI-generated.
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