Unwise, Unworkable and Unlawful: Families USA Urges Trump Administration to Withdraw Medicaid Work Requirements Rule as Comment Period Ends

07.31.2026 / Statement

Comments Spotlight the New "Medical Frailty" Definition Requiring Setting up from Scratch a $4.8 Billion Structure Akin to Social Security Disability Determination

WASHINGTON, D.C. - Today, Families USA, along with hundreds of other consumer, patient, community, and health stakeholder groups submitted comments by today's deadline to the Centers for Medicare & Medicaid Services (CMS) regarding CMS's interim final rule to implement work reporting requirements. Our comments warned of the impacts on Medicaid and the millions of people who rely on the program for health coverage. In response, Families USA Executive Director Anthony Wright issued the following statement:

"Just over one year ago, Congressional Republicans passed the biggest cuts to Medicaid in history, and now the administration is making a bad budget bill worse with additional restrictive regulations. Our comments submitted today spotlight how these Administration rules are unworkable and unlawful, and how they undermine these key public coverage programs. The regulations are a tragic way to mark this week's 61st anniversary of Medicare and Medicaid - pillars of our health care system that millions have relied on for generations.

In a health care system that is already overstretched, inordinately expensive, and wildly complex and confusing, these new paperwork requirements will push patients off coverage - not because they aren't working or not eligible, but because of bureaucratic burdens. While many in Congress promised they would protect the vulnerable and medically frail from these paperwork burdens, the new requirements to get such an exemption are now exponentially more burdensome for both patients and providers.

"By tacking on 'capacity to work' to the definition of medically frail and phasing out self-attestation, CMS has handed states an unwise and unworkable program without the resources or structure to implement it.

The requirement that a patient doesn't just need to have cancer or another condition but must produce the equivalent of a doctor's note with a finding that the conditions leave them unable to work - is nowhere in the underlying statute, and unworkable.

"CMS has designed a program akin to determinations made by the Social Security Administration for determining eligibility for Supplemental Security Income (SSI). SSI's disability-determination system took decades and billions of dollars to build, relying on a nationwide network of trained adjudicators, detailed federal medical criteria, and safeguards like compassionate allowances for the most serious conditions and multi-year redetermination periods. Such a rule would require setting up, in mere months, a regulatory structure bigger and more complicated than Social Security's disability determination system, which after 50 years of maturity costs $4.6 billion a year to administer for 7.4 million recipients. For comparison, the budget bill provides less than 5% of that amount, $200 million, to implement.

"CMS is asking states to replicate that system from scratch, for a Medicaid population several times larger, in a matter of months, with almost no federal guidance, no clinical standards for providers, and none of SSI's basic protections. Families USA estimates the added administrative cost of these work-capacity assessments alone could exceed $4.8 billion a year - on top of the billions states are already spending to stand up work-reporting systems.

"It took the federal government fifty years and billions of dollars to build a disability determination system that still leaves people waiting seven months for an answer. CMS expects states to build something similar for Medicaid in under six months, with no playbook, no dedicated staff, and none of the safeguards that make SSI even marginally workable. The people who will pay for that gap aren't bureaucrats - they're cancer patients, people in mental health crises, and people with disabilities who will lose coverage while paperwork catches up to their diagnosis.

"The implementation deadline of January 1 is looming large, and we hope that over these next few months, CMS takes a long hard look at the thousands of comments it has received from patients and health care providers impacted by the agency's rash and burdensome new requirements."

Families USA has also joined the Association for Community Affiliated Plans (ACAP), Community Catalyst, First Focus Campaign for Children, and National Alliance on Mental Illness (NAMI), in another statement opposing this final rule. Read the full partner statement here.