Trump administration shares new work requirements for Medicaid recipients

The Trump administration this week released guidance for states on the work rules many Americans on Medicaid will need to abide by in order to be eligible for benefits on Jan. 1.

A MARTÍNEZ, HOST: The Trump administration is telling states how to set up work requirements for adults who get their health insurance from Medicaid. That's the program for low-income and disabled people that is funded by the federal government and states. Now, under these new rules, Medicaid recipients will need to prove that they are working, going to school or volunteering at least 80 hours a month. Work requirements were in President Trump's big tax and spending law that he signed last July. That law had a lot of Republican support, and no Democrats in Congress voted for it. Julie Rovner hosts the "What The Health?" podcast. So, Julie, why are Medicaid work requirements such a popular policy for Republicans? JULIE ROVNER: Well, because they sound good and they poll well, and I don't mean that in a flip way. There's a broad consensus that people shouldn't get something for nothing and that if taxpayers are going to underwrite a benefit, people who get that benefit should be expected to pitch in, at least to the extent they can. But Democrats, many of whom in the past have supported work requirements for things like food stamps and welfare benefits, argue that Medicaid and all health insurance is different. For one thing, you don't get a check. You just get your healthcare paid for if you need it. For another, most adults who get Medicaid already do work or go to school or volunteer. Finally, we know that often people end up losing coverage, not because they're no longer eligible, but because they can't successfully jump through all the bureaucratic hoops that these rules require. MARTÍNEZ: All right. So in most places, these rules go into effect January 1. What will states need to do to get that up and running? ROVNER: They're going to have to do a lot. It's going to be expensive. They don't have a lot of time to do it. States have two main determinations that they're going to have to make for Medicaid recipients. First, who might be eligible for exceptions, and second, for those who are subject to the work rules, did they meet them? And the new rules out this week make that even harder for people who can't work. They say states can't just provide a list of ailments, like HIV or cancer, that would automatically exempt people from the work rules. Those people will have to prove that their ailment is serious enough that it also prevents them from working. MARTÍNEZ: You think this is an issue that we'll hear about in the midterms? ROVNER: Yes and no. Not sure of that, specifically for Republicans. It's part of their larger anti-fraud effort to make sure that people who aren't eligible for federal programs aren't getting benefits. For Democrats, it's part of a larger effort to point out how much Republicans are cutting back on needed healthcare at a time health costs are going up rapidly, particularly for those who can least afford it. And I would add that these rules are almost exclusively for states that expanded Medicaid under the Affordable Care Act. That's 43 states, but it doesn't cover some very large, very red states, like Texas or Florida. MARTÍNEZ: I know the Trump administration has an overall plan to cut Medicaid by close to a trillion dollars. How do the work requirements fit into that? ROVNER: Well, the Congressional Budget Office has estimated that the work requirements' portion of last year's budget bill represent about a third of all the Medicaid spending reductions and will increase the number of people without health insurance by more than 5 million people. And remember, many of those people would still be eligible for coverage. They just won't be able to prove that they're meeting the requirements or that they should be exempted from them. MARTÍNEZ: Julie Rovner is chief Washington correspondent with NPR's partner KFF Health News. Thanks a lot. ROVNER: Thank you. (SOUNDBITE OF TOONORTH'S "BADLANDS") Copyright © 2026 NPR. All rights reserved. Visit our website terms of use and permissions pages at www.npr.org for further information. Accuracy and availability of NPR transcripts may vary. Transcript text may be revised to correct errors or match updates to audio. Audio on npr.org may be edited after its original broadcast or publication. The authoritative record of NPR’s programming is the audio record.