CMS Administrator Dr. Mehmet Oz released an interim final rule, with a comment period, that requires certain adults ages 19 to 64 to complete 80 hours per month of work, education, job training, or community service as a condition of eligibility.
The rule, issued under the Working Families Tax Cut bill, establishes a uniform national framework for states to verify compliance, grant exemptions, and report data. States must implement the work requirement by Jan. 1, 2027, though some states have already begun.
The agency is providing $200 million in grants and private-sector technical assistance to help states modernize eligibility systems.
The guidance spells out who must comply, how states will check eligibility at least every six months or at renewal, and who is exempt.
Enrollees must provide documentation to verify medical claims. Currently, enrollees can self-attest until 2028. CMS plans real-time verification using electronic data, such as medical claims.
“This rule helps Americans build skills and independence through work, education, job training, or community service, creating new opportunities for themselves and their families,” Oz said.
A new Health and Human Services study projects the requirements could lift as many as 2.9 million people out of poverty, depending on certain factors such as employment availability.
The interim rule carries out changes Congress made last year in the Working Families Tax Cut legislation, which directed CMS to create nationwide standards for work requirements while allowing flexibility for states.
Officials coordinated extensively with states on eligibility determinations, verification processes, and beneficiary communications to reduce administrative burdens, the agency said.
“The state will be ready to move forward with the work requirements well before the federally mandated start date of Jan. 1, 2027,” Pillen said.
The rule also sets penalties for dishonest self-attestation.
“We are serious about the consequences of dishonesty in self-attestation,” said Oz. “We will be speaking with different enforcement bodies to make sure that folks know that is not a joke.”
Work requirements for Medicaid have been debated for years as part of broader efforts to encourage self-sufficiency and protect resources for the most vulnerable.
“We hope by guiding able-bodied individuals in this initiative, we aim to support their path to independence, but hopefully they don’t need to depend on Medicaid, and are supported by employer-sponsored health plans that would free up critical space in the program for our most vulnerable population to receive the care they deserve,” Oz told reporters on Monday.
Critics, including Rep. Frank Pallone (D-N.J.), said he worries about paperwork becoming a barrier.