New York (AP) — DeAnna Brandon, a 48-year-old blood cancer survivor from Rockwell, North Carolina, fears that new Medicaid work requirements set to take effect next year could jeopardize her health coverage. Brandon, who relies on twice-monthly maintenance chemotherapy to keep her multiple myeloma in remission, had hoped to qualify for a medical frailty exemption.
However, new guidance released last week by President Donald Trump's administration has cast doubt on that possibility.
The interim final rule from the Centers for Medicare and Medicaid Services (CMS) tightens the definition of medical frailty, requiring that a person's condition must "significantly impair" their ability to work, volunteer, or attend school at the mandated rates. For Brandon, who suffers from extreme exhaustion and memory challenges related to her treatments, proving that her symptoms meet this threshold could be a daunting task.
If the government does not accept her case, she could lose her coverage and access to life-saving treatment.
"Working is outside of the realm of possibility for me," Brandon said. "I was always a push-through-it person, but it's hard to explain to people you can't push through it."
The new restrictions, part of Trump's 2025 tax and policy law, affect expansion enrollees aged 19 to 64. They must show they work or perform community service for at least 80 hours a month or are enrolled in school half-time.
Exceptions exist for those deemed medically frail or in addiction treatment, but the new CMS rule narrows the definition of frailty, catching many patients off guard.
Health analysts warn that the rule will increase paperwork burdens for the sickest Medicaid patients, potentially leading to needless loss of coverage. Adrianna McIntyre, a professor at Harvard University's school of public health, said the rule "is going to push in the direction of more people needlessly losing coverage."
States and advocates are confused by the government's approach. CMS Administrator Mehmet Oz endorsed using claims data to automatically exempt eligible enrollees, but the agency later clarified that states cannot categorically exclude individuals based solely on a diagnosis.
For renewal in 2028, verification through claims data or other documentation will generally be required. However, state officials say claims data does not prove significant impairment from working, leaving them unsure how to comply.
Nebraska, which started the work requirements early, used diagnostic codes to identify medically frail individuals and will likely have to rework its system. Sarah Maresh of Nebraska Appleseed expressed concern that doctors in rural areas, already reluctant to take Medicaid patients, may stop altogether due to additional paperwork.
Preparing for the January 1 kickoff is an immense and expensive task. A $200 million federal allotment is helping states, but the total cost for technology and staffing could exceed $1 billion, according to an AP analysis.
Republicans defend the rules as commonsense measures to eliminate freeloading and preserve benefits for those who need them most. Oz cited a report claiming able-bodied Medicaid enrollees spend an average of 6.1 hours a day watching TV or hanging out.
But enrollees like Mids Meinberg, a 42-year-old freelance writer with chronic depression and diabetes, said the characterization is unfair. He works but cannot meet the 80-hour threshold due to his conditions.
Brandon emphasized that she is not 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."