MONITORING: All But the Most Disabled Threatened by Medicaid Work Requirements
New federal work requirements could cause people with disabilities in the Medicaid expansion population to lose coverage — even when they should qualify for an exemption. Medicaid is a critical source of health care and home and community-based services (HCBS) that help many people with disabilities live independently. Last year, H.R. 1 added new work requirements to Medicaid expansion programs, putting coverage at risk for people who may face barriers to work, documentation, or navigating the exemption process.
On June 3, the Centers for Medicare and Medicaid Services (CMS) released a rule explaining how those work requirements will work. Under the rule, most people on Medicaid expansion between ages 19 and 64 must show they are doing at least 80 hours per month of work, school, job training, volunteering, or similar activities to keep their coverage. States must follow this rule by January 1, 2027.
The Problem With the Disability Exemption
The rule does not simply exempt everyone with a disability. Instead, it requires people to show both that they are medically frail or have special medical needs, and that those needs significantly impair their ability to comply with the work requirements. That two-part burden of proof creates a documentation challenge — and raises the risk that people who should be exempt could still lose coverage.
Why it matters: The disability exemption isn't automatic — it requires proving both that you're "medically frail" and that your condition prevents you from meeting the work requirements. That two-part burden of proof could cause eligible people to lose coverage anyway. CMS's own estimates project millions could lose Medicaid.
In plain terms: even if you have a disability, your state may still require you to meet the work requirements. If you can't document your compliance — whether because you truly can't work, because accessible jobs aren't available, or because the paperwork process is unclear — you could lose your health care. CMS's own estimates project that millions of people could lose Medicaid coverage under the rule.
Update: The comment period on this rule has closed, but implementation is still unfolding — states have until January 1, 2027 to put the community engagement requirement in place. ECNV submitted formal comments opposing the rule as written, raising concerns about the medical frailty exclusion, documentation and provider verification burdens, and the need for full ADA and Section 504 accessibility throughout the process. Read our full letter and rationale here.
We'll continue monitoring how Virginia and other states implement this requirement and will share updates here as they develop.
Update: ECNV submitted public comments on this rule, addressing the medical frailty exclusion's burden of proof, documentation and provider verification barriers, and the need for ADA/Section 504-compliant accessibility throughout the process.
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