Too sick to work, but can they prove it? New Medicaid rule worries
patients
[June 12, 2026]
By ALI SWENSON
NEW YORK (AP) — On hot afternoons, DeAnna Brandon’s three dogs zag
around while she splashes in a backyard kiddie pool with her grandkids.
These are the moments the 48-year-old blood cancer survivor cherishes —
and wonders if she will get to have in the years to come.
Brandon, who lives in Rockwell, North Carolina, is worried that new
Medicaid work requirements starting next year could jeopardize her
health coverage. She had expected to qualify for a medical frailty
exemption, but new guidance introduced by President Donald Trump's
administration last week has thrown that into question.
The interim final rule released by the Centers for Medicare and Medicaid
Services means being sick with extreme exhaustion and memory challenges
related to her treatments may not be enough for Brandon to evade the new
work requirements. She will have to attest and later prove that those
symptoms “significantly impair” her ability to fulfill the mandates.
If the government doesn’t accept her case, she could lose her coverage
and the twice-monthly maintenance chemotherapy that keeps her multiple
myeloma in remission. Working is “outside of the realm of possibility
for me,” she said in an interview.
“I was always a push-through-it person — you know, ‘Oh, you’re tired.
Push through,’” Brandon said. “It’s hard to explain to people you can’t
push through it.”
Health analysts have sounded the alarm about the Republican Trump
administration’s newest guidance, which differs from what states had
been expecting. Experts said it will put more Americans at risk of
losing health insurance and force states to scramble in their already
harried efforts to implement the changes on time.
“This will mean more paperwork for Medicaid patients — specifically for
the sickest Medicaid patients,” said Adrianna McIntyre, a professor at
Harvard University’s school of public health. That, she said, "is going
to push in the direction of more people needlessly losing coverage.”
Medical frailty rules may mean paperwork nightmares for sick
people
The new Medicaid restrictions, which Democrats have criticized, were
part of Trump’s big tax and policy law in 2025. The change affects those
covered through an expansion in most states that gave more lower-income
people access to the government’s safety net healthcare program.
Expansion enrollees age 19 to 64 will have to show that they work or do
community service at least 80 hours a month or are in school at least
half the time. There are exceptions for those considered medically frail
or in addiction treatment programs, among others.
Last week’s announcement from CMS caught states off guard with a new
definition of medical frailty. The law had said medically frail people
include those who have substance use disorders, disabilities or serious
medical conditions. But the CMS rule went further, saying someone’s
condition must “significantly impair” their ability to work, volunteer
or attend school at the rates required in the law for them to be granted
an exemption.
In 2027 and once in 2028, the patient can attest that they meet this
definition. But when they try to renew coverage in 2028, they’ll need to
prove it.
Advocates said it is unclear what kind of documentation could prove that
point. They said doctor notes may be required — something some providers
don’t feel comfortable writing. Medicaid enrollees fighting disease may
carry the bureaucratic burden.
Brandon, who tried to prove she couldn’t work to access disability
benefits during her active cancer treatment and failed, said she’s
worried about the hoops she and other patients may need to jump through.
“It’s not that easy — you may have to go through four doctors,” Brandon
said. “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.”
States and advocates are confused by the government's approach
States have been planning to use Medicaid claims data and other data
sources to automatically exempt eligible enrollees whenever possible.
On a call with reporters last week, the CMS administrator, Dr. Mehmet
Oz, endorsed that approach, saying he hoped most people would be helped
"without ever having to talk to anybody.”
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Workers at a Medicaid call center in Jefferson City, Mo., field
questions and review information regarding eligibility
determinations on Aug. 16, 2023. (AP Photo/David A. Lieb, FIle)
 Asked to clarify how the rule should
be implemented, the agency told The Associated Press in an email
that it “chose not to allow states to categorically exclude
individuals from work requirements based solely on a diagnosis or
condition type.” For renewal in 2028, it said, “verification through
claims data or other documentation will generally be required.”
But state Medicaid officials and consultants said Medicaid claims
data doesn’t prove someone is significantly impaired from working,
and they don’t know of any existing data that does. That has left
them confused about how to honor the government's rule.
“States are going to be asked to make a determination using
information that doesn’t exist in their systems,” said Kinda Serafi,
a partner at the legal and consulting firm Manatt Health who is
working with states to make the changes.
One state, Nebraska, started the new Medicaid work requirements
ahead of schedule. But it used diagnostic codes to identify people
who are medically frail, and therefore will likely have to rework
its system, said Sarah Maresh, healthcare access program director at
the advocacy group Nebraska Appleseed.
Maresh said she was concerned doctors in the rural state who are
already reluctant to take Medicaid patients may stop.
“They’re already drowning in paperwork, so to require them to do an
additional step of certifying whether someone is able to work, I
think is concerning,” she said.
Preparing for the Jan. 1 kickoff of the new policies is an immense
and expensive task. A $200 million federal allotment is flowing to
states to help, and CMS has partnered with technology companies to
provide free and discounted services, but the tab for the additional
technology requirements and more staff is likely to exceed $1
billion, according to an AP analysis. That extra cost will be borne
by a mix of federal and state tax dollars.
Republicans say the rules will save Medicaid for those who need
it most
Democrats have slammed the Medicaid work requirements as attacks on
healthcare coverage for struggling Americans.
Republicans promoting the new rules, though, say they are
commonsense measures to eliminate government freeloading and
preserve benefits for people who need them most. Oz last week,
citing a report by the conservative American Enterprise Institute
think tank, said able-bodied people on Medicaid spend an average of
6.1 hours a day “watching TV or just hanging out.”
“This is a concern, not a criticism,” he said. “Work requirements
are going to turn this around, we hope."
Current enrollees who don’t meet the work requirement threshold said
that’s a misrepresentation of their experience.
Mids Meinberg, a 42-year-old freelance writer from New Jersey who
lives with chronic depression and diabetes, said that even with his
health issues, he’s proud to have found a meaningful career. But his
conditions make him unable to work 80 hours a month. He said he
thinks 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.”
Brandon, in North Carolina, said she wants the government to
understand that she’s “not just sitting around wasting time or being
a drain on society.”
“I’m pouring into my grandchildren,” she said. “We’re valuable, and
we can still contribute to our communities even if it’s not
working.”
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