Frail. That’s a word that a lot of people use to describe people like me who use wheelchairs.
That’s not a word that I would apply to myself. It sounds like I’m made of delicate glass or something, and if the wind blows the wrong way, I’ll fall to pieces. And that just ain’t me.
But the day is coming when all sorts of people may be scrambling to dig up any bit of evidence they can to support their claim that they are frail—because they have to in order to be exempted from the federal government’s Medicaid work requirements.
On June 3, the federal Centers for Medicare & Medicaid Services published an Interim Final Rule in the Federal Register that spells out the specifics of the One Big Beautiful Bill Act.
This is the bill that the squatter currently occupying the White House signed into law last July. It requires that by the beginning of next year, roughly 18.5 million adults across forty-two states and the District of Columbia who receive Medicaid benefits must prove they’re working or participating in a similar activity to keep their health coverage—unless they qualify for an exemption.
One way to become exempt is to be “medically frail,” meaning that a person is too disabled to work the minimum forty hours a month needed to satisfy the law’s community engagement requirements.
All of this reminds me of when I was a teen, and some of my peers wanted to have a disability like me, so they could have an automatic exemption from being drafted into the military. But getting out of Medicaid work requirements may prove harder than getting out of being drafted.
Under the new regulations, according to KFF Health News, “having a medical condition alone isn’t sufficient to exempt someone from the work requirements. States must assess ‘the severity of an individual’s condition’ to determine whether they can stay on Medicaid without working—a standard that makes it more difficult for enrollees to meet the criteria.”
And that is clearly what this is all about. It’s another attempt to kick as many people as possible off Medicaid.
During the squatter’s first administration, Medicaid agencies were encouraged to impose new employment requirements as a condition of eligibility. Prior to that time, KFF says, “no states had received waiver approvals to condition Medicaid coverage on work and reporting requirements, and legislative attempts to incorporate work requirements into the Medicaid statute failed.”
The first state to do so was Arkansas, in June 2018. Every Medicaid enrollee aged thirty to forty-nine had to work twenty hours per week or participate in another qualifying community-engagement activity, such as job training or community service. They also had to report to the state every month about how they were meeting those requirements. Anyone who failed to do so three times per year could be kicked off Medicaid.
Disabled people were among those who were exempt from Arkansas’s Medicaid work requirements. But, as often as every two months, they had to file reports with the state confirming that they were still disabled. Again, their Medicaid enrollment could have been terminated if they failed to meet that condition three times in a year.
By December 2018, nearly 17,000 adults had been notified by mail that they had been removed from Arkansas’s Medicaid rolls.
An analysis of the state’s Medicaid work requirement conducted by the Center on Budget and Policy Priorities noted that “the number of people losing coverage exceeds the number who are already working or exempt from the work requirement.” This meant that some people who were supposed to be exempt lost coverage anyway, possibly because they couldn’t keep up with the reporting burden.
In March 2019, a federal judge halted the Medicaid work requirement in both Arkansas and Kentucky.
When former President Joe Biden replaced the squatter in 2021, his administration swiftly revoked the permission granted by the federal government to Arkansas and other states to impose Medicaid work requirements.
But the squatter has returned, and so has the quest to destroy Medicaid. And, this time, being “frail” may not save you.