Trump Administration Issues Work Requirements Regulation
The Trump administration issued draft regulations today that implement work requirements in Medicaid under the One Big Beautiful Bill Act (OBBBA). Able-bodied and non-pregnant adults aged 19 to 64 will be subject to the requirements, with exemptions in place for the medically frail, disabled, and others who are unable to meet the mandates. Individuals can meet the requirement by working, completing community service, or participating in a work program for at least 80 hours per month. States must implement the requirements prior to 2027.
The rule includes broader than expected definitions for “medically frail” people, who are exempt from the mandate. Individuals can also self-attest that they’re exempt once before states require documentation.
Critics argue that most on Medicaid work and that the mandate will lead to eligibility loss due to paperwork and a lack of knowledge of the requirements. States will also spend tens of millions to administer the program. Millions overall are expected to lose eligibility due to the work requirements as well as provider tax restrictions that will impact the generosity of eligibility at the state level.
Healthcare policy group KFF has issued numerous briefers at its site on work requirements.
CMS press release and fact sheet: https://www.cms.gov/newsroom/press-releases/cms-launches-nationwide-framework-implement-medicaid-work-requirements and https://www.cms.gov/newsroom/fact-sheets/medicaid-community-engagement-requirement-certain-individuals-interim-final-rule-comment-period-cms
Additional articles: https://www.modernhealthcare.com/politics-regulation/mh-cms-medicaid-work-requirement-rules-states/ and https://www.healthcaredive.com/news/cms-medicaid-work-requirements-final-rule-state-guidance/821631/ and https://www.beckerspayer.com/payer/medicaid/cms-finalizes-framework-for-medicaid-work-rules-8-things-to-know/ and https://thehill.com/policy/healthcare/5904780-medicaid-beneficiaries-work-requirements/ and https://www.kff.org/medicaid/medicaid-work-requirements-tracker-overview/
#medicaid #workrequirements
KFF Says Child Enrollment Dropped Below Pre-Pandemic Levels
Healthcare policy group KFF finds that child enrollment in Medicaid and children’s health insurance coverage (CHIP) has dropped below pre-pandemic levels. KFF looked at child enrollment in Medicaid and CHIP between February 2020 and February 2026.
#healthcare #coverage #medicaid #chip
CT Bans Hospital Leasebacks
A new CT law bans hospital sale-leasebacks, which is a tactic private equity funds use to extract funds and bankrupt the health systems they control.
#privateequityfirms #hospitals #healthcare
Exchange Bids Due
Exchange bids are due for individual coverage. Rate hikes will continue into 2027 at healthy rates due to rising risks as people drop from the rolls due to affordability issues. Plans have also announced exits. CareSource will exit the Exchanges in Indiana for 2027 coverage.
Additional article: https://www.beckerspayer.com/payer/aca/caresource-to-exit-indiana-aca-marketplace/
#exchanges #healthcare #coverage
https://www.beckerspayer.com/payer/aca/payers-begin-pitching-2027-aca-rates-3-updates/
MA Bid Deadlines Today
Medicare Advantage (MA) plans have a deadline today to submit bids and benefits for 2027. More benefit reductions are expected due to a modest rate hike. Becker’s calls out the likelihood of further supplemental benefit reductions, especially in the area of OTCs, fitness, transportation, and meals.
#medicareadvantage #supplementalbenefits
— Marc S. Ryan
