On June 1 the Centers for Medicare and Medicaid Services (CMS) issued a new rule, designed to cut nearly $1 trillion from the Medicaid budget over 10 years, as called for in U.S. President Donald Trump’s 2025 One Big Beautiful Bill. Critics warn that this new rule will force out of the program an estimated 3 million Americans who meet all qualifications. This rule dictates how states must comply with budget mandates, work requirements, and exemption guidelines.
Many states assumed that people with serious medical conditions would be exempt from work requirements and spent tens of millions of dollars to upgrade technology and hire and train new staff to develop systems to automatically identify recipients in their state systems who would qualify for the exemptions. However, under this new rule, even people with “end-stage” renal disease might not be exempt, and as patients receive treatment, they will have to continue to prove that the treatment did not change their status, and may need to reapply for the exemption.
Anthony Wright, executive director of Families USA, told Common Dreams that “far from protecting the vulnerable, this guidance significantly raises the barrier for demonstrating medical frailty, meaning many patients in the middle of treatment will have the new hassle of proving their condition, over and over, with any mistake or gap being penalized by the loss of their healthcare and coverage.”
