June 03, 2026
National Cancer Institute/UNSPLASH.COM
The Trump administration's new Medicaid work requirements will burden state agencies because the federal government has not provided funding to implement them or train workers, opponents say.
The Trump administration says its new work requirements for Medicaid recipients will reduce the number of Americans in poverty from 2.9 million to 1.6 million.
But the American College of Physicians has pushed back, arguing that the new rules will make it harder for states to determine who is eligible and for people to prove that they are unable to work due to medical conditions. That, the ACP said Tuesday, potentially will lead to a loss of health care coverage for millions of people.
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Research "shows us that instituting work requirements will not meaningfully increase employment," the ACP said in a statement. "Community engagement requirements create a tangle of red tape that diverts resources away from patient care and worsens the administrative burden on physicians. The Medicaid program is designed to ensure that those most vulnerable among us are able to access needed medical care. Instituting work requirements for the program could lead to millions of individuals losing health care coverage, putting at risk their health, financial security, and lives."
The new rules, finalized Monday, take effect Jan. 1. They require most Americans ages 19 to 64 to establish proof that they are working at least 80 hours a month to receive Medicaid. Participation in certain work training or volunteer programs counts toward the minimum. Others must prove they are enrolled in educational programs at least half time, according to a fact sheet from the Centers for Medicare and Medicaid Services.
The One Big Beautiful Bill Act, which President Donald Trump signed into law last summer, aims to cut spending on Medicaid by roughly $1 trillion over the next eight years, without accounting for how much it will cost states to enforce the new rules and potentially leading to the loss of insurance for residents, KFF Health News reported last month.
Many states already are "struggling significantly" with the administration of Medicaid benefits, and there "will be significant additional challenges caused by" the new work requirements, Jennifer Wagner, the director of Medicaid eligibility and enrollment at the Center on Budget and Policy Priorities and a former associate director of the Illinois Department of Human Services, told KFF Health News.
Nearly 3 million Pennsylvania residents and 1.7 New Jersey residents receive Medicaid, according to data compiled by KFF. In both states, about 35% of Medicaid recipients are children, and about 1 in 6 have three or more chronic conditions.
Additionally, 45% of Medicaid recipients in Pennsylvania are working full time, and 27% are working part time. In New Jersey, 43% of Medicaid recipients are working full time, and 28% are working part time.
Pregnant and postpartum women, parents and caretakers of children under 14, people with disabilities and people who are "medically frail" are exempt from the new work requirements.
But part of the problem, for states, is a lack of clarity from the federal government about the definition of "medically frail" and other details of the rules – a sorting out process that will require the hiring of about 250 more staffers and additional education for 6,000 others, Pennsylvania Department of Human Services Secretary Val Arkoosh said last month.
"All of that complexity is now being put into our systems, and we have to do a huge amount of training," Arkoosh testified at a legislative hearing in Philadelphia.
Staff will have to "be retrained on all these very complex processes on top of what is already a complex process," Arkoosh said.
