Trump's new Medicaid rules will kick in, and GOP states are tougher about proving inability to work

Key Points:

• At least six states are requiring immediate medical documentation to prove frailty for Medicaid work exemptions, diverging from federal rules that allow self-attestation for the first year; other states are considering similar measures.
• Advocates warn that requiring documentation upfront may hinder new Medicaid applicants who cannot afford doctor visits, potentially causing coverage loss among vulnerable populations.
• Republican-led states and groups like the Foundation for Government Accountability argue that documentary evidence is necessary to prevent fraud and reduce Medicaid enrollment and costs, projecting significant federal savings.
• The new Medicaid work requirements affect up to 20 million low-income adults in expansion states, mandating 80 hours of work, volunteering, or schooling monthly, with stricter criteria for medical frailty exemptions than previously expected.
• Patient advocates express concern that eliminating self-attestation and relying on medical codes or documentation may disproportionately impact people with mental health or substance use disorders, leading to coverage denials despite legitimate health conditions.