Federal health officials have confirmed that during the past year, certain groups are set to be exempt from new Medicaid work requirements. These exemptions notably include women who are pregnant or have recently given birth, individuals with disabilities or specific medical conditions, as well as parents and caretakers of children aged 13 and younger or those with disabilities. Additional exemptions apply to individuals in treatment for alcohol or drug addiction, American Indians, and Alaska Natives, among others.
In a move to clarify these exemptions, the Centers for Medicare & Medicaid Services (CMS) issued interim guidance on June 1, detailing the procedures states should follow for processing medical frailty exemptions and outlining the specific conditions that qualify. The agency has indicated that to qualify as “medically frail,” individuals must demonstrate that their medical condition significantly impairs their ability to meet the work requirement.
Under the new guidelines, individuals will have the option to self-attest to their medical frailty for the remainder of 2027 and once in 2028. However, after these periods, they will be required to provide documentation to substantiate their claims. Failure to do so may jeopardize their Medicaid coverage.
The issue has sparked legal action, with Democratic plaintiffs arguing that the imposition of work requirements and related exemption rules contravenes constitutional protections and violates federal administrative procedural law. Court documents emphasize the risks faced by individuals with serious health issues, stating, “People with disabilities, patients in the middle of cancer treatment, or those struggling with another serious or complex health condition shouldn’t be at risk of losing the care that helps maintain their health.” The plaintiffs further highlight that the legislation does not stipulate that an individual’s ability to work must be impaired to be considered “medically frail” or to have significant medical needs.
In Pennsylvania, Governor Josh Shapiro has publicly criticized the actions of federal officials, specifically targeting President Biden, Dr. Mehmet Oz, the head of CMS, and Health Secretary Robert F. Kennedy Jr. He accuses them of attempting to deprive vulnerable Pennsylvanians of essential Medicaid services. In a statement shared via social media, Shapiro asserted, “Donald Trump, Dr. Oz, and RFK Jr. are hellbent on trying to push aside people who rely on Medicaid to get the care they need. But here in Pennsylvania, we’re going to keep standing up to protect our most vulnerable Pennsylvanians.”
