Trump's strict Medicaid cuts could leave millions without coverage

The Trump administration's implementation of Medicaid cuts, initially projected to affect 7.5 million people, is proving to be more stringent than expected, exacerbating health access issues for Americans. The policy, part of a larger tax bill, is being enforced with a harsher approach than anticipated, potentially leading to more individuals losing insurance and facing greater difficulties accessing care.

A significant portion of the nearly $1 trillion in Medicaid cuts involves new work requirements for approximately 68 million enrollees. Starting January 1, 2027, able-bodied adults must demonstrate 80 hours of monthly engagement in work, education, job training, or volunteer activities. States have been preparing to implement systems to verify these requirements, but the Centers for Medicare & Medicaid Services (CMS) recently released a lengthy document that has complicated the process.

The law includes exemptions for individuals deemed "medically frail." While states had developed plans to identify these enrollees, CMS's new guidance requires individuals to prove their medical condition impacts their ability to work, rather than relying solely on a list of qualifying conditions or insurance claims data. This stricter stance has surprised states, according to health policy experts, increasing the likelihood of errors in system changes and potentially causing eligible individuals to lose coverage.

Health policy experts express concern that the proposed rules fail to account for the complex realities of people's lives. For some, consistent medical care for chronic conditions is essential for maintaining employment. For others, a serious diagnosis requiring immediate treatment could temporarily hinder their ability to meet work requirements. Individuals with conditions like HIV or those newly diagnosed with cancer needing treatment could be particularly vulnerable to losing their essential health coverage under these new, stringent regulations.

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The stricter stance “was a real surprise to states,” says Adrianna McIntyre, a health policy expert at the Harvard T.H. Chan School of Public Health. “If states have to rush to change their systems, the chance of errors goes up. And in this case, the stakes are high: Errors mean people not getting coverage or losing coverage.”