Is the federal government trying to kick sick people off Medicaid? It certainly seems like it
Congress made the policy choice to impose work requirements on Medicaid — which in itself is likely to result in people losing coverage largely for administrative reasons like failing to file paperwork on time. Now, a rule released by the Centers for Medicare and Medicaid Services (CMS) in June governing how to implement those work requirements is imposing even more administrative burdens, threatening to kick even those who are physically unable to work off their plans
As Stacey Nee, a spokesperson for MassHealth, the Medicaid program in Massachusetts, wrote in a statement to the editorial board, “These new requirements are intentionally designed to be so burdensome to meet that people lose their care.” The statement says the new requirements are “putting people with serious medical conditions, working families, and vulnerable residents at risk of losing the coverage they depend on — not because they’re ineligible, but because of unnecessary red tape.”
Massachusetts Attorney General Andrea Campbell is co-leading a group of 26 states suing to block the CMS rule. Regardless of how the judge rules, the federal government should withdraw the rule and craft a new one that gives states the ability to implement the work requirements in a way that doesn’t overly burden sick and disabled enrollees
Congress’s One Big Beautiful Bill Act requires any able-bodied person on Medicaid to work, volunteer, or attend school — the logic being, as CMS writes, “Employment has been shown to be an important factor leading to long-term beneficiary health and well-being.” In imposing the requirement, Congress ignored data from Arkansas’s Medicaid work requirements suggesting that these requirements don’t increase the number of people on Medicaid who are working, but serve mainly to boot people off Medicaid because they don’t submit reports.
But even supporters of work requirements acknowledge that some people should be exempt. Congress, in the law, exempted people who are “medically frail”; blind; disabled with a substance use disorder, mental disorder, or physical, developmental, or intellectual disability that impairs activities of daily living; or have a “a serious or complex medical condition.”
The problem is the CMS rule seeks to add another condition: Someone who is medically frail or has a serious or complex medical condition has to show that the condition “significantly impairs” their ability to work
That means states can’t grant exemptions because someone has been diagnosed with cancer or Alzheimer’s disease — a determination that could potentially be made automatically through insurance claims data. Instead, a person needs to prove to the state that the illness impairs their ability to work — and it’s unclear how that determination can be made. In 2027, the state can accept “self-attestation” that someone is unable to work when they have no other reliable information, but the federal government limits patients’ ability to use “self-attestation”beyond 2027, suggesting outside documentation would be required. But as the states’ lawsuit points out, most community health providers don’t have the expertise, or time, to do job readiness evaluations.
Jennifer Tolbert, deputy director of the Program on Medicaid and the Uninsured for health policy organization KFF, told the editorial board that the rule “places an administrative burden on providers.” It’s not clear how a physician should evaluate, for example, if a person has a condition that occasionally flares up and prevents them from working, or if a construction worker has a disability that prevents them from doing construction but wouldn’t preclude an office job
The lawsuit argues that the rule runs counter to what Congress intended — to exempt people who are medically frail or have serious illnesses — and to what CMS initially told states by putting people with serious illnesses at risk of losing insurance coverage
Massachusetts has estimated that 300,000 people will lose health insurance coverage through MassHealth or the Health Connector due to various provisions of the One Big Beautiful Bill Act. A MassHealth spokesperson said the state is still calculating any additional impacts of the CMS rule
To their credit, Massachusetts health officials have been developing systems to match MassHealth enrollment data with other datachool, pregnant, or has a child under 13 so the state can automatically determine if a person is exempt from or is already complying with the work requirements, saving them the hassle of filling out paperwork
The Legislature also appropriated $10 million for the state to work with consumer advocacy group Health Care for All to inform MassHealth members about the new requirements. Hannah Frigand, senior director of HelpLine and Public Programs for Health Care for All, said the group will provide funding to community partner organizations — like shelters, faith-based groups, and social services — to do outreach and help people fill out paperwork
Additionally, the fiscal 2027 state budget, which Governor Maura Healey signed on Thursday, appropriates around $30 million for MassHealth to hire staff, communicate with members, and improve its data systems so the state can help people maintain coverage under the new rules
The work requirements will be onerous enough for many MassHealth enrollees. Federal Medicaid officials should work with states to make it as easy as possible to comply. They shouldn’t impose rules that require a low-income person with Parkinson’s disease to jump through bureaucratic hoops to justify why they can’t work in order to receive health insurance
Editorials represent the views of the Boston Globe Editorial Board. Follow us @GlobeOpinion
