WASHINGTON — States will not have to remove anyone from Medicaid for failing to meet the program’s new work requirements until July 1 at the earliest, after the Centers for Medicare & Medicaid Services announced a six-month delay in enforcement on Friday.
The agency called it an optional hold harmless period, and it runs through June 30, 2027. States that take it will still assess whether people meet the work requirement or qualify for an exclusion. But they may not deny an application, or disenroll someone who is otherwise eligible, solely because that person failed to meet the requirement, CMS said.
The requirement itself still takes effect Jan. 1, 2027, for many Medicaid applicants and beneficiaries ages 19 to 64. Under the interim final rule CMS issued in June 2026, people can qualify through 80 hours a month of work, community service or a work program, through enrollment in an educational program at least half-time, through a combination of activities totaling at least 80 hours a month, or by meeting a specified monthly income threshold.
“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,” said Dan Brillman, deputy administrator and director of the Center for Medicaid and CHIP Services.
“If the state can use data to show that someone is working or qualifies for an exclusion, that person should not have to track down paperwork to prove it,”
What the delay changes, and what it does not
CMS said it will not take enforcement action against a state that opts into the hold harmless period. In its letter to state Medicaid directors, the agency asked states to request the flexibility in their mitigation plans by Dec. 11.
The agency also urged states to verify eligibility with data they already hold before asking applicants and beneficiaries for more information, to give people clear and timely notices, to test their systems end to end, and to work with community organizations that can connect people with employment, education, job training and volunteering.
Pressure from states, and a legal fight in the background
The work requirements are among the most contested parts of the sweeping domestic policy and tax law President Donald Trump signed last year. They fall on able-bodied adults without young children who are covered through Medicaid expansion, about 19 million people, and states will have to verify compliance twice a year, according to The Associated Press.
The Congressional Budget Office has estimated that about 5 million fewer people will be on Medicaid a decade from now because of the work requirements, and that most of those people will be uninsured.
CMS Administrator Dr. Mehmet Oz had been under pressure from states and Democratic lawmakers to grant a delay, and states said they were not given enough time to set up the verification systems needed to police the rules. Sen. Ron Wyden of Oregon and Rep. Frank Pallone Jr. of New Jersey wrote to Oz this week asking him to use his discretion to give states more time, according to The Associated Press.
The policy is also being fought in court. Last month, U.S. District Judge Richard Stearns found that CMS had been too onerous in spelling out how chronically ill people must show they are too medically frail to work, in a case brought by Democratic-led states over the agency’s regulation. Democrats, who will take control of Congress in January after last week’s elections, have said they want to roll back the requirements.
The American Cancer Society Cancer Action Network welcomed Friday’s announcement and urged every state to take the delay. “Erecting barriers to accessing health insurance coverage is life-threatening for cancer patients, survivors and all those at risk of developing the disease,” said Lisa Lacasse, the group’s president. The group also asked Congress to delay the work requirements in all states for two years.