Democratic leaders seek delay on Medicaid rules
Sen. Ron Wyden and Rep. Frank Pallone Jr. urge CMS to extend timelines for the 80-hour monthly work requirement taking effect in January.
By Neha Kapoor ·
A federal report projects that 10 million Americans will lose healthcare coverage due to changes in the 2025 budget law. Two senior Democratic lawmakers are now asking the Centers for Medicare and Medicaid Services to delay the implementation of new Medicaid work requirements before the Jan. 1 deadline.
Senate Finance Committee ranking member Ron Wyden of Oregon and House Energy and Commerce Committee ranking member Frank Pallone Jr. of New Jersey sent a letter to CMS Administrator Mehmet Oz on Thursday. They argued that states lack sufficient time to prepare for the new rules. The lawmakers requested that officials use their discretion to grant additional implementation time to protect eligible beneficiaries from losing coverage.
The provision, included in the legislation passed in the summer of 2025, mandates that Medicaid enrollees aged 19 to 65 work, perform community service, or attend education programs for at least 80 hours per month. The law lists several exceptions, including for pregnant individuals, parents with dependent children, and people with complex medical conditions. It also includes a carve-out for those deemed medically frail.
Wyden and Pallone noted that a federal judge recently paused the CMS rule defining medical frailty. They stated this legal hold makes enforcement more difficult for states. The two lawmakers urged Oz to reconsider the agency's definition of the condition. They cited one example where a cancer diagnosis might not satisfy the agency's extra-statutory criteria for exemption.
The letter also asked Oz to approve good faith exemptions submitted by state officials. The lawmakers wrote that Congress provided flexibility in the statute for a reason. They argued the agency should not deny these exemptions out of concern that they reveal policy shortcomings. Pallone and Wyden said they intend to rigorously oversee CMS decisions on these exemptions and the agency's push for implementation despite operational deficiencies.
Wyden and Pallone are scheduled to become committee chairs in early January when Democrats regain control of Congress. They warned that failing to permit state delays would worsen preventable coverage losses. They pledged to hold the administration accountable for those losses.
State officials in West Virginia said this week that approximately 40,000 of the state's 160,000 Medicaid enrollees may lose access to the program in January due to the new requirements.
