States need time to prep for Medicaid work requirements, top Dems in Congress say

WASHINGTON — Two top Democrats in Congress are calling on the Trump administration to delay new requirements for people on Medicaid, arguing there is not enough time for states to prepare before the change takes effect on Jan. 1.

House Energy and Commerce Committee ranking member Frank Pallone Jr., of New Jersey, and Senate Finance Committee ranking member Ron Wyden, of Oregon, wrote in a letter released Thursday that officials must use their “discretion to give states additional time to implement work reporting requirements and protect eligible beneficiaries from losing coverage.”

The two lawmakers, who will become chairmen in early January when Democrats regain control of Congress, added that failure “to permit states to delay implementation despite known operational deficiencies will worsen preventable coverage losses for which Congressional Democrats will hold the Trump Administration accountable.”

Medicaid and the ‘big, beautiful’ law

Republicans included several changes to Medicaid, the state-federal health program for lower income Americans and some people with disabilities, in the “big, beautiful” law they approved in the summer of 2025. 

The provision raised in Pallone and Wyden’s letter requires Medicaid enrollees between the ages of 19 and 65 to work, participate in community service, or attend an education program for at least 80 hours a month.

The law detailed several exceptions, including for pregnant people, parents of dependent children, people who have complex medical conditions, tribal community members, those in the foster care system, people who were in foster care who are below the age of 26 and individuals released from incarceration in the last 90 days, among others.

Republicans also included a carve-out for people who are “medically frail” or who otherwise have “special medical needs (as defined by the Secretary).” 

This summer, CMS released a rule telling states how to determine if someone is “medically frail” and therefore doesn’t need to meet the 80-hours-a-month requirement. 

But that aspect of the law’s implementation is on hold after a federal judge issued a ruling in an ongoing lawsuit, an aspect that Pallone and Wyden wrote makes it even more difficult for states to enforce the new rules once they take effect in the new year.

Pallone and Widen urged Centers for Medicare and Medicaid Services Administrator Mehmet Oz to reconsider what types of diagnoses the administration believes make a person “medically frail.”

“In one example, even a diagnosis of cancer could be insufficient to meet CMS’ extra-statutory definition of ‘medically frail,’” they wrote.

Millions projected to lose access to healthcare

The two also called on Oz to approve any “good faith exemptions” states have sent to CMS to ensure those Medicaid administrators have more time to implement the changes. 

“Congress gave CMS flexibility in the statute for a reason; the agency should not direct states away from good faith exemptions out of concern that they highlight the shortcomings of this policy—not when Americans’ access to health care hangs in the balance,” they wrote. “We intend to rigorously oversee CMS’ determinations on good faith exemptions and its decision to demand states to proceed with implementation even when out of compliance with federal requirements.”

The nonpartisan Congressional Budget Office released a report in July 2025 showing that changes throughout the “big, beautiful” law would result in 10 million people losing access to healthcare.

West Virginia state officials said this week that come January, about 40,000 of the 160,000 Medicaid enrollees in the state will likely lose access to the program due to the new work requirements.