The federal government has given states six more months before they must enforce a new Medicaid work requirement—a policy experts say could leave millions of Americans without health coverage.
The requirement is still scheduled to begin January 1. But under new guidance from the Centers for Medicare & Medicaid Services, states that choose to delay enforcement will not face penalties before at least July 1.
The delay is optional. States that take advantage of it can still begin checking on January 1 whether Medicaid enrollees are working, volunteering, attending school or qualify for an exemption. But no one in those states will lose coverage before July for failing to meet the requirements.
CMS called the six-month window a “hold harmless” period. Dan Brillman, who oversees Medicaid at the agency, said states had made progress and had explained what they need to put the policy in place for beneficiaries over the long term.
“States have made real progress, and they’ve been clear with us about what it takes to get this right for beneficiaries — at scale and for the long term,” Brillman said.
The White House declined to comment.
The announcement marks a notable shift for an administration that has spent months defending the requirement. State officials and health care advocates have warned that the rollout is moving too quickly. They say the added paperwork and administrative hurdles could cause people who qualify for Medicaid to lose coverage.
Some states have already started enforcing the rules. Nebraska began applying its work requirement on May 1. By August, more than 1,000 people had lost coverage or been denied benefits under the new rules, according to state figures.
The work requirement was a central part of President Donald Trump’s “big, beautiful bill,” a sweeping tax and spending package that cut Medicaid funding while providing tax breaks. The law is expected to reduce health coverage and food assistance for millions of Americans.
Under the law, many adults under 65 who are considered able to work must prove they work, volunteer or attend school at least 80 hours a month to keep Medicaid. The program provides health coverage to people with low incomes and people with disabilities.
The Trump administration argues that the requirement will encourage work, reduce waste and protect government benefit programs for those who need them. Critics warn that people could lose coverage because of paperwork problems, even if they qualify for an exemption or are meeting the rules.
The Congressional Budget Office estimated that the work requirements alone would leave 5.3 million more people uninsured by 2034. The office also projected that they would save the federal government $317 billion. Those savings would account for part of the nearly $1 trillion in Medicaid cuts included in the law.
Pressure to delay the requirement had been building for months. Five Democratic governors asked Health Secretary Robert F. Kennedy Jr. last month to postpone implementation, saying state agencies were not ready.
A federal judge also blocked the Trump administration last month from enforcing part of the requirement involving people considered medically frail. The judge warned that the rule could cause some people to lose coverage by mistake.
The delay comes just over a week after Democrats won control of both chambers of Congress, campaigning on a promise to reverse Republican cuts to health care and food assistance.
Sarah Lueck, vice president for health policy at the Center on Budget and Policy Priorities, said the law had left states scrambling to meet a rushed timeline while federal requirements continued to shift.
“Millions of people’s health care is at risk because of the Republican reconciliation law’s work requirement, as states scramble to implement on a rushed timeline & respond to shifting federal requirements,” Lueck wrote in a post on X. “Today’s news lets states delay the harm.”
The six-month window gives states more time before they can be penalized for delaying enforcement. But the work requirement remains in place, and states that use the delay are still expected to begin checking beneficiaries’ eligibility in January.
