Millions to lose health insurance under new Trump-era Medicaid work rules

Starting in 2027, a new federal law will impose work requirements on millions of Americans to maintain their Medicaid health insurance. The "One Big Beautiful Bill Act," championed by the Trump administration and supported by Republican lawmakers, aims to combat waste, fraud, and abuse within the Medicaid program.

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The beneficiaries who are part of the population covered by the Medicaid or Medicare expansion must work or volunteer at least 80 hours per month, attend school at least part-time, or participate in job training programs.

Under the new regulations, individuals enrolled in Medicaid expansion must work, volunteer, attend school, or engage in job training for at least 80 hours per month. Certain exemptions exist, but critics argue they are too narrow. The law includes a limited exclusion for "medically fragile" individuals, but states have broad discretion in defining this, and the rules implicitly link medical fragility to the ability to work.

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the bill requires enrollees in the Medicaid expansion aged 19 to 64 to work, volunteer, attend school, or participate in an employment program unless they qualify for certain exemptions.

Estimates suggest that these requirements could lead to approximately 5.3 million more people losing their health insurance by 2034. Advocates express concern that the hurdles could be insurmountable for many, including those actively battling serious illnesses like cancer, HIV/AIDS, and hepatitis. While the first year allows for self-declaration of meeting exemption criteria, states can verify these using available data from 2027 onward.

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about 5.3 million more people remain uninsured in 2034 due to the work requirement, according to an estimate by the Congressional Budget Office in 2025.