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Starting next year, most states will begin reviewing who is sick enough to be excused from new federal Medicaid work rules. People who study the nation鈥檚 public aid system have said they have an idea of headaches likely to come.
That鈥檚 because states already determine who鈥檚 sick enough to access Medicaid鈥檚 disability coverage 鈥 a process known to have administrative hurdles and blunders.
Take Taya Hailstone from Roundup, Montana. She鈥檚 19 and is in remission from Hodgkin lymphoma. The cancer left lasting damage to her organs.
Hailstone has relied on Medicaid鈥檚 disability coverage for years. But the state decided last year she鈥檚 no longer eligible, after she opted not to renew her Social Security disability payments. She did that because she鈥檇 hoped to get healthy enough to work. But some days, her pain makes daily tasks hard. Hailstone said she still needs Medicaid to afford specialty treatment to manage the cancer鈥檚 aftereffects. But letters from her doctors show state officials didn鈥檛 ask for her latest medical records before switching her coverage.
鈥淚t feels like this process was made to make you give up,鈥 Hailstone said.
Incoming federal rules mean more adults will face a similar process 鈥 and potentially lose health coverage. To keep Medicaid, people accessing the low-cost health insurance solely based on their income must prove they鈥檙e working, going to school, or volunteering. Congressional Republicans鈥 One Big Beautiful Bill Act set a January deadline for states to start those checks.
Out of the 18.5 million people estimated to have to meet the new requirements, more than 40% live with a chronic health condition. Some will qualify for medical exemptions.
But with states set to review medical cases for a larger swath of Medicaid enrollees, now public aid researchers, attorneys, and advocates are worried the processes will be convoluted and lead to more people being denied coverage they need.
鈥淭his will be the story of millions of people,鈥 said Anthony Wright, who heads the nonprofit Families USA.
Getting a work requirement exemption will be especially hard for people who can’t easily access healthcare.
Families USA and other organizations have argued the new rules force states to set up a patchwork of systems that together would be larger and more complicated than the Social Security Administration’s own disability system, which last year cost more than $5 billion to administer. For comparison, Wright said, the federal law provided $200 million for states to share as they set up the work requirements.
As for Hailstone, she鈥檚 trying to convince the state of Montana that her disabilities haven鈥檛 gone away. She鈥檚 appealing her case and has access to Medicaid in the meantime.
As state governments grapple with how to determine who鈥檚 sick enough to be excused from new Medicaid work requirements, some families are already struggling with what illnesses guarantee health coverage because of a disability.
