Health

States get six more months before Medicaid work rules can cost people their coverage

Washington • November 13, 2026 • By Press Pass USA

The headquarters of the Department of Health and Human Services, which oversees the Centers for Medicare and Medicaid Services

File photo: American College of Cardiology

The Trump administration told states Friday they will not have to remove anyone from Medicaid for failing to meet the new work requirement until July 1, giving state agencies six more months to get their systems ready — but the requirement itself still takes effect on January 1.

The Centers for Medicare and Medicaid Services announced an optional six-month "hold harmless" transition period running through June 30, 2027. During that window, no one who is otherwise eligible can lose coverage — or be denied coverage — solely because they failed to meet the work requirement. States that are ready may enforce the rules from January; states that are not ready will not face federal penalties until July.

States will still have to determine whether many enrollees and applicants are meeting the new requirements: working, in school or volunteering. Under the policy, many Medicaid beneficiaries must work or volunteer at least 80 hours a month or be in school at least half-time. The rule applies only to people who receive Medicaid under the voluntary expansion that 40 states undertook to cover more lower-income adults without children at home. There are exceptions for people over 64, those caring for children under 14 and those deemed too medically frail to work.

The work requirements were established by the sweeping domestic policy law President Donald Trump signed last year, the One Big Beautiful Bill Act. CMS said states are making progress but have implementation challenges, and the extra time will let them improve their processes before full enforcement begins.

"States have made real progress, and they've been clear with us about what it takes to get this right for beneficiaries — at scale and for the long term," Dan Brillman, deputy administrator and director of the Center for Medicaid and CHIP Services, said in the agency's statement.

Advocates for enrollees welcomed the breathing room but warned it changes nothing about the underlying risk. "I think these extra six months are going to give states the ability to respond to the change, and there will be fewer people that lose their coverage due to administrative failures," Kathy Hempstead, a senior policy officer for the Robert Wood Johnson Foundation, told The Associated Press. Kate McEvoy, executive director of the National Association of Medicaid Directors, said state Medicaid leaders "appreciate the additional flexibility that CMS is providing."

The decision also gives Congress some breathing room. Democrats who are taking control of both chambers in January after sweeping election victories last week have said they want to roll back the requirements. The news comes after Democratic Senator Ron Wyden of Oregon and Representative Frank Pallone Jr. of New Jersey wrote to CMS Administrator Dr. Mehmet Oz this week asking him to delay the work reporting requirements, citing in part a recent Boston federal court decision that medically frail people should not be bound by the work requirement rules.

Critics of the policy say most enrollees covered by the mandate are already working, and that people are more likely to lose coverage because of the paperwork to prove it than because they are failing to work. Nebraska, the first state to launch the requirements in May, offers an early warning: preliminary data showed that more than 9 in 10 people subject to the requirement and due to have their benefits renewed in July and August qualified — but 533 people were denied continuing coverage, most of them over paperwork. Of those denied, 43 lost coverage because they did not meet the new requirement.

For now, the delay is a reprieve, not a repeal. The work requirements remain the law, and enforcement arrives on July 1, 2027, whether states are ready or not.

Sources: Associated Press, "US gives states another 6 months before they have to remove people from Medicaid for not working" (Nov. 14, 2026, full text verified); The Wall Street Journal, "Trump Administration Delays Rollout of Medicaid Work Requirements" (Nov. 13, 2026); Centers for Medicare and Medicaid Services statement (Nov. 13, 2026, via AP and WSJ).