2026-06-06T16:00:09.280Z / https://www.cnn.com/2026/06/06/politics/medicaid-work-requirement-rules-cancer-patients
- 一项新的联邦规定令患病的医疗补助计划参保者更难获得工作要求豁免资格，该工作要求将于明年1月在大多数州生效。
- 若想申请医疗虚弱豁免，参保者的健康状况必须严重影响其工作能力。
- 患者权益组织警告，更严格的标准可能导致患有严重疾病的参保者失去医保 coverage。
由人工智能生成的摘要经CNN编辑审核。
随着多数州将于明年1月首次实施联邦工作要求，数百万患病美国人将更难保留——甚至无法申请——医疗补助计划的参保资格。
这是因为美国医疗保险与医疗补助服务中心（CMS）本周发布了一项新规定，在界定哪些低收入成年参保者有资格获得“医疗虚弱”豁免方面采取了更强硬的立场。该规定为各州落实工作指令提供指导。
根据周一发布的这项规定，要想获得豁免，参保者不仅必须患有癌症或行为健康问题等疾病或医疗状况，还必须证明该状况严重影响其遵守工作指令的能力。
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这一解读令许多州和患者权益组织感到意外，并立即引发强烈抗议，各方警告此举将剥夺通过医疗补助计划扩面参保的患病参保者亟需的医保保障。
“这会给那些患有严重疾病、一旦失去医保可能遭遇灾难性后果的人增加更多维持参保的负担，”为各州提供医疗补助政策咨询的法律与咨询公司Manatt Health高级常务董事乔斯林·盖耶说道，“这会增加失去医保的人数。”
这项工作指令被纳入特朗普总统及其所属政党去年通过的《一项宏伟美好法案》（One Big Beautiful Bill Act）。美国医疗保险与医疗补助服务中心正在发布相关规定，协助各州落实该法案中的医保条款，其中包括对医疗补助计划的历史性削减。该机构表示，其工作要求的核心目标是提高医疗补助参保者的自给自足能力和经济流动性，同时保护弱势群体。
《一项宏伟美好法案》要求19至64岁的医疗补助扩面参保者每月至少工作80小时、从事志愿活动、上学或参与职业培训项目，除非他们符合某些豁免条件。国会预算办公室去年夏季的估算显示，由于这项工作要求，到2034年 uninsured 人数预计将增加约530万。
但专家告诉CNN，将豁免与参保者无法工作挂钩的条款并未出现在该法案本身中。
该规定引发了众多患者权益组织的迅速回应，他们表示，更严格的解读会危及参保者的医保保障和就医机会，从而危及人们的生命。
“由于这些要求，一名正在积极接受癌症治疗、为生命而战的患者如今还必须克服某些人看来难以逾越的障碍，才能获得或维持医保资格，”美国癌症协会癌症行动网络的政策副主管詹妮弗·霍克说道，“如果他们没能及时通过审核系统，在去做化疗或癌症手术时就会发现自己没有所需的医保。他们的救命治疗将被剥夺。”
包括美国肺脏协会、克罗恩病与结肠炎基金会以及全国精神疾病联盟在内的48个患者组织表示，美国医疗保险与医疗补助服务中心的解读“明显与《一项宏伟美好法案》相悖”。
该组织在一份声明中称：“将法律规定的医疗虚弱豁免重新定义为仅适用于能够证明自己无法工作的个人，并大幅限制各州从2028年起接受患者关于合规和豁免情况自我声明的能力，这明显与该法案相悖。”
“这些政策将给患者和医疗机构带来大量文书工作负担，打乱各州数月来的规划工作，并在距离2027年1月的实施截止日期仅数月之际引发混乱。”
美国医疗保险与医疗补助服务中心未回应记者就倡导者担忧提出的置评请求。
这一出人意料的解读给州医疗补助机构增加了额外的两步门槛，而这些机构本已面临着在明年1月前建立工作要求项目的紧迫截止日期。许多机构已经根据美国医疗保险与医疗补助服务中心的非正式指导搭建了系统，现在必须做出调整。与此同时，内布拉斯加州上月已经启动了其工作指令，但现在必须符合这项新规定。
更复杂的是，无党派健康政策组织KFF的医疗补助与未参保人群项目副主任詹妮弗·托尔伯特表示，美国医疗保险与医疗补助服务中心并未向各州提供如何界定和评估个人是否符合医疗虚弱豁免标准的指导。各州可能会采取不同的做法，这意味着将不会有统一的标准来判断某人是否因病情过重而无法工作。
正如该规定所指出的，进一步复杂化的是，这些参保者的病情严重程度及其对工作能力的影响可能会随时间变化。
该条款还可能让医生陷入两难境地，因为他们可能被要求协助判断某人是否能够工作，而这会影响患者的医保覆盖情况。盖耶表示，这通常不属于医疗服务提供者的临床实践和专业领域。
此外，从2028年开始，参保者和新申请医疗补助的人员仅被允许进行一次自我声明，以证明自己符合医疗虚弱豁免资格。此后，如果各州没有存档数据来确认个人的参保资格，参保者可能必须提供证明文件，这对部分人来说可能难度极大。
各州也无法为豁免条件增加额外类别。例如，该规定指出，无家可归不会自动将一个人归类为医疗虚弱，因为这种情况不属于健康状况。但如果该人同时患有物质使用障碍或精神健康状况，则有资格获得豁免。
美国医疗保险与医疗补助服务中心官员在与记者的电话会议上为其对法律的解读进行了辩护，此次电话会议主要围绕医疗虚弱条款展开。他们表示，各州可以使用健康索赔数据或要求提供其他文件来确定参保者是否符合该规定中的标准。
“这项豁免确保工作要求针对的是能够参与的人群，同时保护那些无法参与的人，”美国医疗保险与医疗补助服务中心医疗补助项目主管丹·布里尔曼说道。
负责监督美国医疗保险与医疗补助服务中心、同时也是特朗普政府打击联邦项目欺诈行动关键人物的穆罕默德·奥兹博士将这些条款与维持项目的完整性联系起来。
“我们一直秉持的理念是，我们心怀宽容，但绝不愚蠢，”奥兹在接受记者采访时表示，他指出工作指令将为弱势群体保留医疗补助计划，“从方向上看，我们正恰当地针对问题领域采取行动，方式既富有同情心、宽容大度——但我们不想当傻瓜。”
医疗虚弱豁免是美国医疗保险与医疗补助服务中心对《宏伟美好法案》做出更严格解读的几个例子之一。从2028年开始，该机构将取消参保者自我声明自己符合工作要求或有资格获得豁免（如作为护理人员）的权利，这对零工或个体经营者而言可能至关重要。
2027年，当没有可靠数据来证明工作时长或豁免资格时，各州可以接受自我声明。
奥兹警告参保者在进行自我声明时必须诚实。
“在极少数需要自我声明的情况下，你必须如实告知，”他在周一对记者说道，“我们将与不同的执法机构沟通，确保大家知道这不是开玩笑。”
此外，美国医疗保险与医疗补助服务中心上月提议一项规定，进一步限制各州提高对医疗服务提供者某些类型支付的能力——超出国会在该法案中设定的限额。这些支付原本用于鼓励医疗服务提供者参与，并改善医疗补助参保者的就医可及性，但该机构认为，这种做法推高了成本，却未确保更好的健康结果。
这项更严格的工作要求规定至少获得了一位保守派健康政策专家的认可。帕拉贡健康研究所主席、对白宫和共和党议员具有影响力的布莱恩·布拉瑟表示，该规定在保护医疗补助计划完整性与照顾有需要的人之间“达成了适当平衡”。
“仅靠自我声明来证明合规性或豁免资格——尤其是针对医疗虚弱情况——可能会重演其他项目在验证标准放宽后出现的不当参保和欺诈问题，”他在一份声明中说道。
The Trump administration makes it harder for some sick Americans to maintain Medicaid
2026-06-06T16:00:09.280Z / https://www.cnn.com/2026/06/06/politics/medicaid-work-requirement-rules-cancer-patients
- A new federal rule makes it more difficult for sick Medicaid enrollees to qualify for an exemption from work requirements, which start in January in most states.
- To qualify for the medical frailty exemption, enrollees’ health condition must significantly impairs their ability to work.
- Patient advocacy groups warn the stricter standard could result in enrollees with serious medical conditions losing coverage.
AI-generated summary was reviewed by a CNN editor.
Millions of sick Americans could have a tougher time retaining — or even signing up for — Medicaid coverage after the first-ever federal work requirement begins in January in most states.
That’s because the Centers for Medicare and Medicaid Services issued a new rule this week that takes a harder line on defining which low-income adult enrollees are eligible for an exemption for those who are“medically frail.” The rule guides states on implementing the work mandate.
To qualify for the exemption, not only must enrollees have an illness or medical condition, such as cancer or a behavioral health issue, but that condition must also significantly impair their ability to comply with the work mandate, according to the rule, released Monday.
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The interpretation came as a surprise to many states and patient advocacy groups and immediately sparked an outcry, with warnings that it will strip needed health coverage from sick enrollees covered through Medicaid expansion.
“It is going to impose a lot more burdens to keeping coverage on people who have very serious conditions for whom loss of coverage can be catastrophic,” said Jocelyn Guyer, senior managing director at Manatt Health, a legal and consulting firm that advises states on Medicaid policy. “It will increase the number of people who lose coverage.”
The work mandate was included in President Donald Trump and his party’s One Big Beautiful Bill Act, which passed last year. CMS is in the process of issuing rules to help states implement the health provisions in the law, which includes historic cuts to Medicaid. The agency said its key focus for work requirements is to increase Medicaid enrollees’ self-sufficiency and economic mobility, while protecting the vulnerable.
The OBBBA requires Medicaid expansion enrollees ages 19 through 64 to work, volunteer, attend school or participate in a job program at least 80 hours a month, unless they are eligible for certain exemptions. Some 5.3 million more people are expected to be uninsured in 2034 because of the work requirement, according to a Congressional Budget Office estimate from last summer.
Tying the exemption to an enrollee’s inability to work, however, is not in the law itself, experts told CNN.
The rule prompted a swift response from a multitude of patient advocacy groups, who say the stricter interpretation will put people’s lives at risk by jeopardizing their coverage and access to care.
“Because of these requirements, an individual fighting for their life in active cancer treatment will now also have to have to climb what, for some, will be insurmountable obstacles to get or maintain coverage,” said Jennifer Hoque, associate policy principal at the American Cancer Society Cancer Action Network. “If they aren’t able to get through the system fast enough, they’ll show up to chemo or show up for cancer surgery and find out they don’t have the coverage they need. Their lifesaving treatment will be taken from them.”
CMS’ interpretation “clearly conflicts” with the One Big Beautiful Bill Act, according to a group of 48 patient organizations, including the American Lung Association, the Crohn’s & Colitis Foundation, and the National Alliance on Mental Illness.
“Redefining the law’s medical frailty exemption to only apply to individuals who can prove they cannot work and drastically limiting the ability of states to accept self-attestation from patients about compliance and exemptions starting in 2028 clearly conflicts with the law,” the group said in a statement.
“These policies will place massive paperwork burdens on patients and providers, upend months of planning by states and create chaos just months away from the January 2027 implementation deadline.”
CMS did not reply to a request for comment about advocates’ concerns.
The surprise interpretation adds an extra, two-step hurdle for state Medicaid agencies, who are already facing tight deadlines to stand up their work requirement programs by January. Many have already been setting up their systems based on informal guidance from CMS and must now make changes. Meanwhile, Nebraska launched its work mandate last month but will now have to conform to the new rule.
What’s more, CMS did not provide guidance to states on how to define and assess whether a person meets the medically frail exemption criteria, said Jennifer Tolbert, deputy director of the Program on Medicaid and the Uninsured at KFF, a nonpartisan health policy organization. States will likely adopt different practices, meaning there won’t be a uniform standard for determining if someone is too sick to work.
Further complicating matters is that the severity of these enrollees’ medical conditions — and the impact on their ability to work — can vary over time, as the rule noted.
The provision could also put doctors in a tough spot, since they may be called upon to help determine whether someone is able to work, which would affect their patient’s coverage. That is not typically part of providers’ clinical practice and area of expertise, Guyer said.
Plus, starting in 2028, enrollees and those signing up for Medicaid will only be allowed to self-attest that they qualify for the medical frailty exemption once. After that, if states don’t have data on file to confirm people’s eligibility, enrollees may have to provide documentation, which could prove to be a big lift for some.
States also will not be able to add additional categories to the exemption. For instance, the rule notes that being homeless would not automatically qualify a person as medically frail since that circumstance is not a health condition. However, if that person had a substance use disorder or mental health condition, they could be eligible for the exemption.
CMS officials defended their interpretation of the law in a call with reporters, which largely focused on the medical frailty provisions. States can use health claims data or ask for other documentation to determine whether an enrollee meets the criteria in the rule, they said.
“The exemption ensures that work expectations are directed towards those who can participate, while protecting those who cannot,” said Dan Brillman, who directs CMS’ Medicaid program.
Dr. Mehmet Oz, who oversees CMS and is a key player in the Trump administration’s crackdown on fraud in federal programs, linked the provisions to maintaining the program integrity.
“The mantra that we kept coming back to was that we’re forgiving but we’re not foolish,” Oz told reporters, noting that the work mandate will preserve Medicaid for the vulnerable. “Directionally, we are appropriately going after problem areas and doing it in a way that’s compassionate, forgiving — but we don’t want to be fools.”
The medically frail exemption is one of several examples of CMS’ stricter interpretations of the Big Beautiful Bill. Starting in 2028, the agency is eliminating the ability for enrollees to self-attest that they are meeting the work requirement, which can be important for gig workers or the self-employed, or that they qualify for an exemption, such as serving as a caregiver.
In 2027, states can accept self-attestations when there is no reliable data available to prove work hours or exemption eligibility.
Oz warned that enrollees must be honest when self-attesting.
“In the rare instance where you’re self-attesting, you need to tell the truth,” he told reporters on Monday. “We will be speaking with the different enforcement bodies to make sure that folks know that’s not a joke.”
Also, CMS last month proposed a rule that would further curtail states’ ability to boost certain types of payments to providers — beyond the limits Congress included in the law. These payments are used to encourage provider participation and improve access to care for Medicaid enrollees, but the agency argues that the practice drives up costs without ensuring better health outcomes.
The stricter work requirement rule met with the approval of at least one conservative health policy expert. Brian Blase, the president of Paragon Health Institute and an influential voice with the White House and Republican lawmakers, said it “strikes the appropriate balance” between protecting Medicaid’s integrity and accommodating those in need.
“Self-attestation alone for compliance or exemptions — particularly for medical frailty — risks repeating the improper enrollment and fraud seen in other programs when verification standards were weakened,” he said in a statement.
