The Trump administration has released a new rule requiring able-bodied adults who gained Medicaid coverage through Obamacare’s expansion to spend at least 80 hours per month working, studying, participating in job training, or engaging in community service to remain eligible beginning in 2027.
The guidance specifies that exemptions for medical frailty must be based on functional limitations rather than diagnosis. Critics argue the rule is too strict because it does not automatically exempt beneficiaries with certain health conditions.
The rule aims to ensure Medicaid’s integrity by preserving work requirements for most expansion beneficiaries while safeguarding those who are medically frail.
Congress created Medicaid in 1965 to serve low-income children, seniors, and people with disabilities. Obamacare expanded coverage to working-age adults with incomes up to 138% of the federal poverty level—a group now accounting for nearly one-fourth of all beneficiaries.
Under the rule, beneficiaries earning $580 per month (equivalent to 80 hours at the federal minimum wage) are automatically compliant. If they can meet this threshold with fewer hours, they need not log all 80 hours.
The Department of Health and Human Services recently reported that Medicaid work requirements could increase family income by more than $12,000 annually and lift between 1.6 million and 2.9 million people out of poverty.
However, the rule addresses concerns about abuse in previous exemptions. Before this guidance, at least 29 states planned to allow self-attestation for medical frailty without rigorous verification, potentially enabling widespread evasion of work requirements.
Medicaid already faces challenges with improper payments, including over $37 billion in fraudulent claims reported by federal officials in 2025 alone.
Sally Pipes is President, CEO, and Thomas W. Smith Fellow in Healthcare Policy at the Pacific Research Institute.
