Dr. Mehmet Oz, administrator of the Centers for Medicare and Medicaid Services, presented new work requirements for Medicaid recipients at a White House briefing on Tuesday. The nearly 400-page interim final rule released Monday requires adults ages 19 to 64 in more than 40 states that expanded Medicaid under the Affordable Care Act to prove they are working, attending school, or volunteering at least 80 hours per month starting January 1.
The requirements are part of a broader $900 billion cut to Medicaid included in the budget bill President Trump signed on July 4, 2025. That legislation passed without any Democratic support and used major reductions to Medicaid to fund tax cuts and immigration enforcement priorities. The Congressional Budget Office estimated that about one-third of the total Medicaid cuts will come from the work requirements themselves, with approximately 5 million people expected to lose coverage.
What the Right Is Saying
Dr. Oz defended the work requirements as promoting personal responsibility. "If you're sitting at home, which is true for the millions of people who are able-bodied on Medicaid, on average, you're spending 6.1 hours watching television, or just hanging around," he said at Tuesday's briefing. "So, as a path to prosperity, Congress very wisely said, 'Let's get you back into the workforce."
The Paragon Health Institute, a conservative policy group closely aligned with the Trump administration, released a statement saying the rule "strikes the appropriate balance between necessary program integrity protections and accommodations for those who genuinely need assistance." Republicans have long championed work requirements as a mechanism to encourage employment among able-bodied adults.
What the Left Is Saying
Adrianna McIntyre, assistant professor of health policy at the Harvard T.H. Chan School of Public Health, said states were already operating under a tight timeline to implement such sweeping changes. "It takes states literally months — usually years — to make the types of changes to their systems that they needed to make for this new rule," she said. McIntyre noted that while federal officials had informally assured states people with serious conditions would be exempt, the published rule requires that a condition must be "actively interfering" with ability to work to qualify for an exemption. Under that standard, she explained, patients in early-stage cancer treatment who still have work capacity or individuals living with HIV but able to work would not be protected.
A coalition of 48 patient organizations wrote in a joint statement: "Our organizations are deeply concerned the interim final rule does not protect people with serious or complex health conditions and would instead dramatically and inappropriately increase the number of people who will lose their healthcare coverage." Carl Schmid, executive director of the HIV + Hepatitis Policy Institute, said his organization had lobbied for months seeking a blanket exemption for people living with HIV. "We're just going to lose people to Medicaid and then they're going to get sick and then they're going to die," he said. The group plans to file comments on the rule and pursue state-level exemptions, with Schmid predicting litigation may follow.
Jennifer Wagner, who analyzes Medicaid eligibility at the left-leaning Center on Budget and Policy Priorities, pointed out that unlike other federal programs with work requirements such as food assistance, there is no funding provided to help recipients find or maintain employment. "That just implies or suggests that somebody could get a job if they wanted — they just need a little shove," Wagner said. "Which just reflects a complete lack of understanding of what people are actually going through." She expects the complex reporting requirements will cause eligible people to lose coverage even when they qualify for exemptions, citing prior experience with similar policies in Medicaid and other programs.
What the Numbers Show
The Medicaid program covers approximately 68 million low-income Americans jointly funded by states and the federal government. An analysis of government data by KFF found that most adults currently enrolled in Medicaid are already working. Approximately one in five beneficiaries do not meet the proposed 80 hours-per-month threshold, with barriers including inability to find employment, job layoffs, or retirement.
The CBO projected 5 million people will lose Medicaid coverage under the new requirements. The $900 billion in total Medicaid cuts represents a significant reduction to the program that serves as the primary health insurance for low-income adults and children across the country. States must build, test, and launch new verification systems before the January 1 implementation deadline.
The Bottom Line
The interim final rule is open for public comment until July, giving advocates an opportunity to push for modifications before it becomes permanent. Patient groups like the HIV + Hepatitis Policy Institute have committed to filing formal comments and pursuing exemptions at the state level despite expressing frustration with the current framework. Some Republican-led states are moving forward early with implementation, while others await further federal guidance ahead of the January deadline. Whether the rule survives potential legal challenges or modifications during the comment period will determine how many people with serious health conditions face loss of coverage during ongoing treatment.
No funding has been allocated to support beneficiaries in finding employment, meaning those who fail to meet reporting requirements may lose health insurance without any additional assistance gaining work. The combination of a compressed timeline, complex verification processes, and narrow exemption criteria is drawing criticism from medical providers and patient advocates across the political spectrum.