CMS Issues Rule Requiring 80 Hours of Monthly Work for Some Medicaid Adults, Projected to Save $326 Billion but Cost States in Implementation

The Centers for Medicare & Medicaid Services issued an interim final rule on Monday requiring some adults enrolled in Medicaid to work 80 hours per month to keep coverage. States must generally put the rule into effect by Jan. 1, 2027.

State health departments are expanding staff, paying overtime and upgrading computer systems to track compliance. They are also building new processes to decide who qualifies for exemptions when applicants are judged too sick to work. Politico reported on Sunday that several states are complaining about the added expense.

Many Democratic officials say the requirements are straining budgets already pressured by lower tax collections and federal funding cuts tied to President Donald Trump’s 2025 One Big Beautiful Bill Act. Virginia Secretary of Health and Human Services Marvin B. ” Republican state lawmakers who back the policy have also noted the cost.

Missouri Sen. Brad Hudson said, “We don’t have a bunch of extra money to go around. We had to make cuts this year. 3 million people.

Republicans argue the rules target only able-bodied adults and are needed to reduce waste, fraud and abuse. 3 billion in Medicaid payments to California, citing insufficient action against fraud in the program.