Chronically ill people face confusion over new Medicaid work rules and ‘medically frail’ exemption — SkimNews
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- Nebraska begins enforcing Medicaid work requirements (80 hours of work, volunteering, or school per month) next week, with Arkansas, Montana, and Iowa launching their programs before a nationwide January 1 rollout.
- CMS narrowed the medical frailty exemption in its June rule: patients with serious or complex conditions can no longer be automatically qualified — they must document how their illness impairs daily tasks like eating, bathing, and walking, and self-attestation ends in 2028.
- Democratic attorneys general argued before a district judge Tuesday that the June CMS rule diverged from earlier guidance states had relied on to administer exemptions, with a ruling that could shape the exemption in more than two dozen states.
- The Congressional Budget Office projects more than 7 million people will lose Medicaid coverage under the new requirements, per estimates cited by STAT.
- Arkansas's prior state-level work requirement experiment became the cautionary precedent: roughly half of low-income adults at risk of losing coverage had serious health impairments, and people who should have qualified for exemptions were kicked off the rolls.
- Crystal Schroer, a 31-year-old Nebraskan with depression, ADHD, and panic disorder, landed a full-time administrative job at a university days before Nebraska's enforcement date — after more than a year of searching for stable work in rural Kearney.
Why it matters: Patients with serious chronic conditions risk losing health coverage not because they fail work requirements but because proving exemption under the new CMS rule requires documentation many providers and patients can't compile in under six months. With CBO projecting 7 million+ will lose coverage and a Harvard professor warning annual exemption paperwork 'is going to break the system,' states must build vetting infrastructure before January while courts decide the rule's fate.
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