Public Health — News & Analysis

Medicaid's new work-requirement rule sets a trap for disabled enrollees, advocates warn (June 23, 2026)

June 23, 2026 — A First Opinion piece in STAT by Maria Town, president of the American Association of People with Disabilities, and Nicole Jorwic, chief program officer at Caring Across Generations, argues that the Centers for Medicare and Medicaid Services' new Medicaid work-requirement rule creates a Catch-22 for disabled enrollees.

When the One Big Beautiful Bill Act passed last year, cutting Medicaid by nearly $1 trillion, Congress explicitly exempted people with disabilities from the new 80-hour-per-month work mandate, the authors write, and lawmakers including House Energy and Commerce Committee Chair Brett Guthrie repeatedly promised that exemption would hold. But the proposed CMS rule goes further than the statute requires: to qualify for the "medically frail" exemption, a disabled person must now declare they cannot work at all — targeting the very population the exemption was meant to protect.

The authors describe the practical effect: a person with an intellectual disability working part-time may spend 40 hours a week coordinating accessible transportation and support just to manage 5 to 10 hours of paid work, hours the rule doesn't count toward exemptions; because their work hours fall short of the 80-hour threshold, their own employment could become the reason they lose coverage. Town and Jorwic cite Urban Institute projections that Medicaid work requirements will strip coverage from more than 5 million people by 2034 and note that evidence from states that have already tried such requirements, including Arkansas, shows they fail to boost employment while increasing state costs. They call on CMS to drop the inability-to-work standard before the rule is finalized.