New York — On a hot afternoon, DeAnna Brandon’s three dogs roam while she swims in the backyard kid’s pool with her grandchildren. These are the moments the 48-year-old leukemia survivor cherishes, and wonders if she’ll have them for years to come.
Brandon, who lives in Rockwell, North Carolina, is concerned about that New Medicaid Work Requirements starting next year could jeopardize her health coverage. She expected to qualify for a medical impairment exemption, however New directives Serve it Administration of President Donald Trump Last week brought this into question.
The interim final rule issued by Centers for Medicare and Medicaid Services That means she’s sick with extreme fatigue and memory challenges related to her treatments may not be enough for Brandon to evade the new work demands. She will later have to testify and prove that these symptoms “substantially impair” her ability to carry out new tasks.
If the government doesn’t accept her case, she could lose her coverage for the treatment — and the twice-monthly maintenance chemotherapy that keeps multiple myeloma in remission. She said in an interview that the work was “out of the realm of possibility for me.”
“I’ve always been a driven person — you know, ‘Oh, you’re tired,’” Brandon said. “Pay it forward.” “It’s hard to explain to people that you can’t get through this.”
Health analysts have sounded the alarm over the Republican Trump administration’s latest guidance, which differs from What countries were expecting. Experts said that would put more Americans at risk of losing their health insurance and force states to scramble their already arduous efforts to implement the changes on time.
“This will mean more paperwork for Medicaid patients — especially for the sickest patients on Medicaid,” said Adriana McIntyre, a professor at Harvard School of Public Health. She said this “will cause more people to lose coverage unnecessarily.”
New medical restrictions They were part of Trump’s Big Tax and Policy Bill In 2025. This change affects those covered by the expansion, which most states chose to do, which gave more low-income people access to the government’s safety net health care program.
Expansion registrants between the ages of 19 and 64 will have to prove that they work or perform community service at least 80 hours per month or that they attend school at least half-time. There are exceptions for those who are considered medically vulnerable or in addiction treatment programs, among others.
CMS’s announcement last week surprised states with a new definition of medical frailty. The law stipulates that medically vulnerable people include those with substance use disorders, disabilities, or serious medical conditions. But a CMS rule last week went further, saying someone’s condition must “substantially impair” their ability to work, volunteer or attend school at the rates required by law for them to be granted an exemption.
In 2027 and once in 2028, a patient can attest that he or she meets this definition. But when they try to renew coverage in 2028, they’ll have to prove it.
It’s unclear what kind of documentation could prove that point, advocates said. They said doctor’s notes may be required — something some providers don’t feel comfortable writing. Medicaid enrollees battling the disease may bear the bureaucratic burden.
Brandon, who tried and failed to prove she couldn’t work to get disability benefits while in active cancer treatment, said she’s worried about the hoops she and other patients may need to jump through.
“It’s not that easy, you might have to go through four doctors,” Brandon said. “If you actually have a disease like this, you don’t have the physical, mental or emotional energy to do it all the time.”
States plan to use Medicaid claims data and other data sources to automatically exempt eligible enrollees whenever possible.
Content Management System Administrator Dr. Mehmet Oz On a call with reporters last week, he supported this approach, saying he hoped most people would get help “without having to talk to anyone at all.”
When CMS was asked to clarify how it would implement the rule, The Associated Press said in an email statement that the agency “has chosen not to allow states to categorically exclude individuals from work requirements based solely on diagnosis or type of condition.” For renewal in 2028, “verification through claims statements or other documentation will generally be required,” she said.
But state Medicaid officials and consultants said the claims Medicaid data doesn’t prove that someone has significant work impairment, and they don’t know of any existing data that proves that. This has left them confused about how to respect the government’s rule.
“States will be asked to make a decision to use information that is not in their systems,” said Kinda Serafi, a partner at Manat Health, a consulting firm that is working with states to make the changes.
one state, nebraska, New Medicaid work requirements have begun Before the specified date. Sarah Maresh, health care access program director at the advocacy group Nebraska Appleseed, said it has used diagnostic codes to identify medically vulnerable people and therefore will likely have to rework its system.
Maresh said she’s concerned that doctors in the rural state who are already reluctant to take Medicaid patients might decide to stop.
“They’re already overwhelmed with paperwork, so asking them to take the extra step to certify whether someone is able to work, I think, is concerning,” she said.
Preparing for the new policies to go into effect on January 1 is an enormous and expensive task. A $200 million federal allotment is flowing to states to help, and CMS has partnered with technology companies to offer free and discounted services, but the tab for additional technology requirements and more employees is likely to exceed $1 billion, according to an AP analysis. This additional cost will be incurred through a combination of federal and state tax dollars.
Republicans Promote new rules They say they are common-sense measures to eliminate free government exploitation and preserve benefits for the people who need them most. Healthy people on Medicaid spend an average of 6.1 hours a day “watching TV or just hanging out,” Oz said last week, citing a report from the conservative American Enterprise Institute think tank.
He added: “This is a concern, not a criticism.” “Work requirements will hopefully change that situation, we hope.”
But current registrants who do not meet the work requirement threshold said this is a misrepresentation of their experience.
Meds Meinberg, a 42-year-old freelance writer from New Jersey who suffers from chronic depression and diabetes, said that even with his health problems, he is proud to have found a meaningful career. But his circumstances make him unable to work 80 hours a month. He said he believes there are many people with disabilities who are “too disabled to work but not disabled enough that the state believes they are unable to work.”
Brandon, of North Carolina, said she wants the government to understand that it “is not just sitting around wasting time or draining the community.”
“I gush over my grandchildren,” she said. “We are valuable, and we can still contribute to our communities even if it’s not successful.”