2026年4月13日 10:06 UTC / 路透社
作者：阿米娜·尼亚斯
2026年4月13日 10:06 UTC 更新于1小时前
美国医疗保险与医疗补助服务中心（CMS）负责人穆罕默德·厄兹与美国副总统JD·万斯一同在华盛顿特区艾森豪威尔行政办公楼谈及打击欺诈问题，2026年2月25日。路透社/凯文·拉马克 资料图
- 政策专家表示，联邦拨款无法覆盖各州成本
- 各州将在未完全自动化系统的情况下推出相关要求
- 保险机构等待细则以帮助管理参保人合规情况与沟通工作
纽约，4月13日（路透社）——据六位行业专家透露，特朗普政府推出的要求美国人必须工作或志愿服务才能获得医疗补助（Medicaid）医保福利的新法案将于明年生效，但目前各州仍在等待合规细则，且承诺的拨款有限。
行业专家表示，唐纳德·特朗普总统2025年减税与支出法案中拨出的2亿美元用于各州落实工作要求的资金，预计无法满足许多州的实际需求。
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此外，针对管理医疗补助福利的各州与保险机构的豁免对象、志愿服务资格等详细指导，预计要到6月才能发布。
与针对65岁及以上人群、由联邦政府全额拨款的医疗保险不同，针对低收入美国人的医疗补助成本由各州与美国政府共同承担。
行业与政策专家表示，该法案将于明年1月1日生效，部分州可能会寻求延期，并分阶段推出相关系统。
健康咨询公司萨洛健康策略首席执行官马特·萨洛将该系统的推出比作“餐厅的软开业”。
萨洛曾担任全国医疗补助主管协会前执行董事，他表示：“不会立刻看到人们被取消参保资格。”
根据健康政策机构KFF的数据，约有6800万人参保医疗补助计划，其中近一半人面临失去医保覆盖的风险。
这些计划由联合健康集团（UNH.N）、CVS健康旗下的安泰保险（CVS.N）、益维信（ELV.N）、森科健康（CNC.N）和莫利纳医疗（MOH.N）等保险公司管理。
两位投资者与一位分析师表示，此次推出可能会给保险公司带来混乱，但新政策对企业的影响最终会趋于平稳。
美国医疗保险与医疗补助服务中心的一位发言人表示，政府一直在拨付资金，并正在与各州合作推进落实工作。
他们表示：“CMS已经为各州提供了大量支持”，并“将通过临时最终规则以及与各州的持续接触，继续提供更多指导。”
该拨款的一半将在50个州平均分配——每个州约200万美元——而另一半则取决于受工作要求约束的州居民数量，这位发言人表示。
艾奥瓦州、犹他州与佐治亚州正在筹备
艾奥瓦州卫生与人类服务部的一位发言人表示，该州已经开始着手落实工作，并预计其技术成本将超过收到的联邦拨款。该州是已向政府提交实施计划的六个州之一。
同样提交了计划的犹他州，州卫生部门一位发言人表示，他们预计拨款足够，但仍在等待政府发布具体指导细则。
佐治亚州自2023年起就有自己的工作要求，该州社区卫生部一位发言人表示，该州正在评估已收到的500万美元拨款是否充足，同时等待最终规则中关于社区参与要求的细节。
佐治亚州的现有要求适用于通过《平价医疗法案》医疗补助扩展计划获得额外福利的人群。
缺乏最终规则只能盲目推进
六位行业专家表示，政府的最终规则预计将明确文件与核查要求、详细说明豁免资格人群，并概述报告机制。
该法案大体规定，参保人必须定期记录并证明自己每周工作或志愿服务20小时。豁免人群包括残疾人、孕妇和儿童。
各州可以通过连接就业数据经纪公司或其他追踪就业状况的州政府机构等外部团体自行开展核查，但统计志愿服务时长可能颇具挑战。
预算与政策优先中心的政策专家阿里·加德纳表示，目前几乎不清楚志愿者组织在核实志愿服务时长方面将扮演何种角色，也几乎没有信息说明各州将如何在其系统中自动化完成该报告流程，他称这种情况“非常令人担忧且存在问题”。
保险公司将助力维持参保率
行业与政策专家表示，保险公司希望维持成本与参保率稳定，它们很可能在与参保人沟通方面发挥重要作用，因为它们拥有先进的基础设施，且已经与参保成员保持直接联系。
安泰保险的一位发言人表示，该公司正在为部分医疗补助参保人对接工作机会，并正在等待州与联邦政府的指导细则。安泰保险在15个州运营医疗补助计划。
这位发言人说：“我们合作的大多数州仍处于新要求的规划阶段，我们正与它们密切沟通，探讨如何支持其落实工作。”
加德纳表示，如果没有联邦政府发布的细则，保险公司无法启动有效的参与项目。
加德纳还表示，本应由电子系统完成的工作将不得不手动完成，这可能会增加错误率，导致人们被取消参保资格。
“预留的时间根本不够。”
阿米娜·尼亚斯报道；卡罗琳·胡默与比尔·伯克罗编辑
States, insurers await needed details to implement new US Medicaid work rules
April 13, 2026 10:06 AM UTC / Reuters
By Amina Niasse
April 13, 2026 10:06 AM UTC Updated 1 hour ago
Administrator for the Centers for Medicare & Medicaid Services Mehmet Oz speaks next to U.S. Vice President JD Vance about combating fraud, at the Eisenhower Executive Office Building, in Washington D.C., U.S, February 25, 2026. REUTERS/Kevin Lamarque/File Photo
- Federal funding does not match state costs, policy experts say
- States to launch requirements without fully automated systems
- Insurers await rules to help manage enrollee compliance and communication
NEW YORK, April 13 (Reuters) – The Trump administration’s new law that Americans must work or volunteer to qualify for Medicaid healthcare benefits, set to take effect next year, has left states waiting for details on how to comply and with limited funding promised, according to six industry experts.
The $200 million set aside for states to implement the work requirements in President Donald Trump’s 2025 tax cuts and spending bill is expected to fall short of many states’ needs, the industry experts said.
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In addition, detailed guidance to states and insurers who manage Medicaid benefits about who is exempt and what volunteer work qualifies, is not expected until June.
Unlike Medicare for those ages 65 and older, which is fully funded by the federal government, costs of Medicaid for low-income Americans are shared between the states and the U.S. government.
With the law going into effect on January 1, some states may seek extensions and partially launch their systems, industry and policy experts said.
Matt Salo, CEO of health consultancy Salo Health Strategies, likened the rollout of the system to “a soft opening of a restaurant.”
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“You’re not going to see people get kicked off immediately,” said Salo, a former executive director of the National Association of Medicaid Directors.
About 68 million people are enrolled in Medicaid plans, and nearly half are at risk of losing coverage, according to health policy firm KFF.
The plans are managed by insurers such as UnitedHealth Group (UNH.N), CVS Health’s (CVS.N) Aetna, Elevance (ELV.N), Centene (CNC.N) and Molina (MOH.N).
The launch may be messy for insurers, but the impact of the new policy on companies should even out over time, two investors and one analyst said.
A spokesperson for the U.S. Centers for Medicare and Medicaid Services said the government has been distributing funds and is working with states on implementation.
“CMS has provided significant support to states,” they said, and “will continue to provide additional guidance through the interim final rule and ongoing engagement with states.”
Half of the funding is divided evenly across the 50 states – about $2 million per state – while the other half is dependent on how many state residents are subject to the work requirements, the spokesperson said.
IOWA, UTAH AND GEORGIA ARE PREPPING
A spokesperson for Iowa’s Department of Health and Human Services said the state has begun working on implementation and expects its technology costs to exceed the federal funding received. It is one of half a dozen states that have filed implementation plans with the government.
In Utah, which has also filed its plan, a state health department spokesperson said it expects the funding to be adequate but that it is still waiting on specific guidance from the government.
Georgia, which has had its own work requirements since 2023, is assessing whether the $5 million in funding it has received is enough as it waits for the final rule’s details on community engagement requirements, a spokesperson for Georgia’s Department of Community Health said.
Georgia’s state requirement applied to people receiving additional benefits through the Affordable Care Act’s Medicaid expansion.
FLYING BLIND WITHOUT FINAL RULES
The government’s final rule is expected to define documentation and verification requirements, provide specifics on who qualifies for exemptions and outline reporting mechanisms, the six industry experts said.
The law generally says enrollees must regularly document and verify they are working or volunteering 20 hours a week. Exempt enrollees include people with disabilities, pregnant women and children.
States can independently carry out verifications by connecting to external groups like employment data brokers or other state agencies tracking employment status, but compiling volunteer hours may be challenging.
There is little clarity on what role volunteer organizations play in verifying volunteer hours and little information on how states will automate that reporting in their systems, said Ali Gardner, policy expert at the Center for Budget and Policy Priorities, calling the situation “really concerning and problematic.”
INSURERS TO HELP KEEP PEOPLE ENROLLED
Insurers, who want to keep costs and enrollment steady, are likely to play a major role in managing communication with enrollees as they tend to have advanced infrastructure and are already in direct contact with members, industry and policy experts said.
Aetna is connecting some Medicaid members with job opportunities and waiting for state and federal government guidance, a spokesperson said. Aetna operates Medicaid plans in 15 states.
“Most states with which we work are still in the planning phase of these new requirements, and we are in close communication with them about how we can support their implementation,” the spokesperson said.
Gardner said without the details from the federal government, insurers have not been able to launch effective engagement programs.
And work that should be done by electronic systems would need to be done manually, which could increase errors and cause people to be disenrolled, Gardner said.
“There’s not enough time built in.”
Reporting by Amina Niasse; editing by Caroline Humer and Bill Berkrot
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