CMS Releases 400-Page Federal Rule Implementing Medicaid Work Requirements

The Centers for Medicare and Medicaid Services released a nearly 400-page rule on Monday afternoon that sets federal standards for states to carry out Medicaid work requirements. The rule was issued June 3, 2026. It contains directives from the Trump administration that Medicaid leaders and advocates say are stricter than earlier federal descriptions.

Much of the discussion centers on the medical frailty exemption. Under the new rule, obtaining that exemption will be more difficult than most people had expected. Benjamin Sommers, an economics professor at the Harvard T.

H. Chan School of Public Health, said the change will affect people with high medical needs. “This is where we’ll see large and harmful coverage losses,” Sommers said. “This is a population that has high medical needs and is at major risk for harm if they lose coverage.