| The Trump administration rolled out its new rules for Medicaid’s work requirements, and is partnering with tech companies to help streamline verification, but there are concerns about who could lose coverage under the system. The rules require certain people on Medicaid — a joint federal-state health program for low-income people — to prove they are working, volunteering, attending school or participating in a qualifying job-training program for 80 hours per month to keep their coverage. It’s part of what was outlined in the One Big Beautiful Bill Act, Republicans’ signature domestic policy law enacted last July. → There are several exemptions from the work requirements, but some advocates and health policy experts are already worried about the strict definition of what it means to be “medically frail,” which the Centers for Medicare and Medicaid Services has outlined in the new rule. The law had allowed for people who are “medically frail” to be carved out from the new requirements, but it did not define the term. → In the rule, CMS ultimately tied medical frailty to an individual’s ability to work or otherwise satisfy the requirements, rather than broadly exempting people whose health conditions could deteriorate if they lose coverage. “The mantra we kept coming back to was that we’re forgiving, but we’re not foolish,” CMS Administrator Mehmet Oz told reporters on a call Monday. “If we make it so easy to defraud [Medicaid] — that everyone feels that they’re fooled for not defrauding it — that’s not so good,” he said. The Trump administration says it wants to shield people on Medicaid from having to submit burdensome paperwork to prove they’re complying with the requirements or qualify for exemptions. CMS envisions states using information already available, such as medical claims from doctors’ visits, to verify compliance and determine eligibility for carveouts. But whether that vision materializes will largely depend on how states build their verification systems, and what documentation they ultimately require from beneficiaries. The administration is betting that technology and automation can prevent the paperwork problems that plagued earlier state work requirement efforts. - $200 million: The amount the Republicans’ domestic policy law sets aside for states to implement new Medicaid-related requirements and rules. Dan Brillman, who oversees Medicaid at CMS, told reporters Friday that states could each receive between $2 million and $20 million.
“We’re encouraging investments in tech improvements and a data-first approach,” Brillman said, adding that the federal government is paying for 90 percent of the cost for states to implement the new technology. - Brillman told reporters that states already automate between 50 percent and 60 percent of Medicaid renewals, which the administration wants to “improve … even more” through data automation.
→ The funding comes on top of the $600 million in partnerships that CMS had announced making with technology companies in January to help states modernize Medicaid systems and carry out the work requirements certification. - 15 million: The Medicaid program covers roughly 68 million Americans who are poor or disabled. The administration estimates that about 20 million of them will be adults in 2027, when the new requirements kick in. CMS has calculated that about 75 percent of those adults — or about 15.3 million people — will be subject to the requirements because they don’t qualify for an exemption.
- 3 million: CMS estimates that the work requirements will result in 3.1 million to 3.3 million people losing Medicaid coverage each year once they’re fully implemented, which the administration admits is “subject to uncertainty.” The calculations don’t account for people who’ve found health insurance elsewhere, such as through work or on the individual marketplace.
→ However, other estimates have been much higher, including one analysis from the Robert Wood Johnson Foundation that found that up to 10 million people could lose Medicaid coverage in 2028. The administration is taking public comments on the rule, which comes in at roughly 400 pages, through the end of July. → Congressional Democrats swiftly criticized the Trump administration’s work requirements rule, and some industry groups expressed skepticism of the approach. “Work and community engagement are important goals, but [the] success of any Medicaid program should be measured by health outcomes,” said Ceci Connolly, who leads the Alliance of Community Health Plans, an association for smaller health plans. “It would be a mistake to claim victory purely based on the number of Americans who lose coverage.” → In 2018, Arkansas became the first state to implement Medicaid work requirements before being halted by a court. More than 18,000 people lost coverage within months, largely because beneficiaries struggled to navigate reporting requirements. Researchers at the Harvard T.H. Chan School of Public Health found that employment levels didn’t increase following the work requirements, but about half of the people in Arkansas who lost their Medicaid coverage struggled to pay off medical debt or delayed care due to cost. State data show that just 11 percent of the people who lost coverage in 2018 were able to get it back the following year. Elon Musk’s neurotechnology company Neuralink has also added Arnold & Porter, its second lobbying firm on retainer, to its roster of outside consultants. I reported in Health Brief on Monday about the company hiring Jeffrey J. Kimbell & Associates. → Both firms are being contracted to advocate before the federal government on issues related to the “development and commercialization of brain-computer interfaces.” “Conservative group alleges 6 million were fraudulently enrolled in ACA,” The Post’s Dan Diamond reports. “This scientist learned he has a devastating brain disease. He set out to cure it.”, reports Carolyn Y. Johnson at The Post. “Trump Megadonor Gave $5.5 Million Estate to Robert F. Kennedy Jr.’s Anti-Vaccine Group,” Rebecca Davis O’Brien and Theodore Schleifer report at the New York Times. “Bipartisan group of lawmakers unveil new bill to restrict China biotech,” Max Bayer reports at Endpoints News. “The Autism-Therapy Business Is Booming—and So Is the Billing Abuse,” report the Wall Street Journal’s Christopher Weaver and Anna Wilde Mathews. This newsletter is published by WP Intelligence, The Washington Post’s subscription service for professionals that provides business, policy and thought leaders with actionable insights. WP Intelligence operates independently from The Washington Post newsroom. Learn more about WP Intelligence. | 
