Overview
- CMS, which announced the interim final rule Monday, requires most nonpregnant adults in Medicaid expansion coverage to show roughly 80 hours per month of work, school or community service to remain eligible.
- The rule lists specific exemptions for pregnancy and postpartum care, medically frail beneficiaries, caregivers, American Indian and Alaska Native people, former foster youth and some veterans and bars states from adding new exemption categories.
- States may accept self‑attestation of compliance through the end of 2027 but must begin stricter verification and documentation checks in 2028, with compliance checks at renewals or at least every six months.
- CMS is offering about $200 million in federal grants while estimating one‑time state IT upgrades of roughly $15 million each and total system costs near $1.52 billion through 2036, leaving states to cover gaps.
- Public health groups, patient advocates and nonpartisan analysts warn the verification rules and paperwork will cause millions to lose coverage through administrative churn rather than increase employment, and the rule is open for public comment through July 31, 2026.