The federal government on Friday announced a six-month delay in implementing a Medicaid work requirement — a central provision of President Donald Trump’s “big, beautiful bill” that experts say would lead to millions of Americans losing their health coverage.
Technically, the requirement still begins on January 1, but under new guidance from the Centers for Medicare & Medicaid Services, states that choose not to enforce it will not be held accountable until at least July 1.
The move marks a striking turning point for an administration that has spent months defending the policy against criticism from state officials and health care advocates who have warned that the rollout is moving too fast and that people who should be eligible for Medicaid would lose coverage because of the additional red tape and paperwork.
CMS has called the six-month window a “hang” period, and the deadline is optional. States that choose to take advantage of this period will still begin checking on January 1 whether Medicaid enrollees are working, volunteering or in school or whether they qualify for an exemption. But until July, no one in those states will lose coverage for failing to meet the requirements.
“States have made real progress and they have been clear with us about what needs to be done to benefit beneficiaries — at scale and over the long term,” said Dan Brillman, who oversees Medicaid at CMS.
The White House declined to comment.
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Some states have already made progress in implementing work requirements. In Nebraska, which launched work requirements on May 1, more than 1,000 people lost coverage or were denied benefits because of the new rules, according to state figures through August.
The Medicaid work requirement was the cornerstone of Trump’s “big, beautiful bill,” a massive tax and spending program that massively benefited the wealthy through tax breaks while gutting the social safety net for vulnerable Americans. Millions of Americans are expected to lose health coverage and food assistance because of the law, the signature domestic legislation of Trump’s second term.
The law requires many able-bodied adults under 65 to prove they work, volunteer or attend school at least 80 hours a month to retain Medicaid, which provides health coverage to low-income and disabled Americans. The Trump administration argues that this requirement and other provisions of the law encourage work, reduce waste and protect government benefit programs for those who need them.
The Congressional Budget Office estimated that work requirements alone would leave 5.3 million more people uninsured by 2034 and save the federal government $317 billion, part of the nearly $1 trillion in cuts in the Medicaid law.
Pressure on the administration to delay implementing the requirement had been building for months. Last month, five Democratic governors asked Health Secretary Robert F. Kennedy Jr. to delay implementation, saying state agencies were not ready. And last month, a federal judge blocked the Trump administration from enforcing part of the requirements related to medically fragile people, saying it could lead some people to wrongly lose coverage.
The delay comes just over a week after Democrats took control of both houses of Congress on their promise to reverse the Republican Party’s cuts to health care and food aid.
“The health care of millions of people is at risk due to the work requirements of the Republican Reconciliation Act, as states scramble to implement it on a rushed timeline and meet changing federal requirements,” said Sarah Lueck, vice president of health policy at the Center on Budget and Policy Priorities, in an article on X. “Today’s news allows states to delay the damage.”
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