Five governors are asking the Trump administration for more time before Medicaid's new work rules take effect, warning that people who still qualify for coverage could lose it because state systems will not be ready to process their paperwork. In an Oct. 1 letter to Health and Human Services Secretary Robert F. Kennedy Jr., the governors asked HHS to extend the Jan. 1, 2027, compliance date, according to Oregon Gov. Tina Kotek's office.
The signers are Kotek of Oregon, Gavin Newsom of California, Janet Mills of Maine, Michelle Lujan Grisham of New Mexico and Abigail Spanberger of Virginia, all Democrats. The rules apply to roughly 21 million people who gained Medicaid eligibility through the Affordable Care Act expansion, Healthcare Dive reported.
For households, the warning raises a practical question with fewer than 100 days left. If you or a relative is covered as an expansion adult, is your address current, and do you know whether you qualify for an exemption? The governors' prediction of paperwork-driven losses is their view, not a finding, and no public HHS response to the letter had been reported as of Oct. 4.
Governors Say the June Federal Rule Upended State Plans
Under the 2025 federal budget law and an interim final rule released June 1, non-pregnant adults ages 19 to 64 in the expansion group must show 80 hours a month of work, community service, a work program or half-time school, or earn at least $580 a month. If a state cannot verify compliance, it must send a notice and give the person 30 calendar days to respond, according to a CMS fact sheet on the interim final rule.
The governors argue the rule went further than states expected, including tighter standards for proving medical frailty and a required order for verifying information. "These are not minor or technical adjustments. They fundamentally change the processes and system logic underlying states' implementation plans," the letter states.
"With less than 100 days remaining before January 1, states cannot reasonably rebuild, test and validate these systems while ensuring accurate notices, properly trained workers and reliable, lawful coverage determinations," the governors wrote, as quoted by the Oregon Capital Chronicle. They asked HHS to use enforcement discretion that ties compliance to each state's demonstrated readiness instead of a fixed date, Becker's Hospital Review reported.
The governors also wrote that "despite our policy disagreement, we have never allowed it to interfere with our obligation to implement the law Congress enacted." Kotek said one-third of Oregon families rely on Medicaid through the Oregon Health Plan. "We're working to ensure people who are eligible have a pathway to stay insured," she said. Her office noted that a similar multistate letter in May did not win the requested changes.
Nebraska's Early Numbers Point to Missed Paperwork
Nebraska became the first state to enforce the rules in May. State data cited by Healthcare Dive show almost 560 new applicants subject to the requirements were denied, about 84% because they could not provide information verifying compliance. About 530 people renewing coverage were terminated, 92% for not responding to verification requests.
MedicalDaily previously reported that most Nebraskans denied at renewal missed paperwork requests, with only 43 renewal denials tied to failing the work test itself. So far, unanswered paperwork, not a lack of work, has driven most losses.
That evidence has limits. Nebraska's figures cover a few months of a phased rollout in one state, and they do not show how many people denied were actually eligible. The governors also point to a Congressional Budget Office projection that roughly half of an estimated 5 million coverage losses by 2034 would stem from paperwork and reporting failures. They cite Arkansas' 2018 program as well, where a study found more than 95% of people subject to the rules already met them or qualified for exemptions, yet about 18,000 people lost coverage.
Administration Defends Work Rules as Path to Independence
Federal officials describe the requirements as a way to connect enrollees with work and community life. "Community engagement provides dignity and purpose," Kennedy said in a January CMS announcement.
In the same release, CMS Administrator Dr. Mehmet Oz called community engagement more than a policy requirement, describing it as "an opportunity for states to modernize Medicaid systems while strengthening connections to work, education, and community-based opportunities."
The rule remains in force despite a lawsuit. Twenty-five states and the District of Columbia sued over it on June 29, and on July 29 a federal judge in Massachusetts denied their request to block the rule while the case proceeds. HHS did not immediately respond to the Capital Chronicle's request for comment on the governors' letter.
The people most exposed are not those refusing to work. They include enrollees who recently moved or changed phone numbers, workers with irregular gig or seasonal hours, people with chronic illnesses who must now document frailty, and those without reliable internet. Parents juggling jobs and caregiving may also miss a 30-day response window.
Steps Enrollees Can Take Before January
The simplest step is to make sure your state Medicaid agency has your current mailing address, phone number, and email. Open every letter from the agency, even if it looks routine, and answer verification requests quickly.
Next, check whether you may be exempt. Federal exemptions cover pregnant and postpartum people, parents or caretakers of children 13 or younger, people who are medically frail, veterans with a total disability rating, American Indians and Alaska Natives, former foster youth, and people in drug or alcohol treatment. Nebraska's work requirements page shows how one state lists exemptions and lets people report online, by phone, by mail or in person.
Keep pay stubs, school records and volunteer logs together. If you have a serious health condition, talk with your clinician about documentation, since the new rule says a diagnosis alone is not enough to verify medical frailty. Community health centers, legal aid groups and enrollment navigators can help, often for free.
What comes next hinges on HHS's response, the ongoing lawsuit and whether states finish their systems on time. For now, Jan. 1 remains the deadline, so the most protective move for families is to update contact information and gather records well before notices arrive.
Key Questions Answered
Which governors signed the letter?
Oregon Gov. Tina Kotek, California Gov. Gavin Newsom, Maine Gov. Janet Mills, New Mexico Gov. Michelle Lujan Grisham, and Virginia Gov. Abigail Spanberger sent the Oct. 1 letter to HHS Secretary Robert F. Kennedy Jr.
What are the governors asking for?
They want HHS to extend the Jan. 1, 2027, compliance date or use enforcement discretion tied to each state's readiness. They say a June federal rule changed key verification steps too close to the deadline.
Who has to meet the work requirements?
Non-pregnant adults ages 19 to 64 covered through Medicaid expansion must generally show 80 hours a month of work, school, volunteering, or a work program, or earn at least $580 a month, unless they are exempt.
Is it confirmed that eligible people will lose coverage?
No. That is the governors' warning. Nebraska's early data show most denials so far came from unanswered verification requests, but those figures do not show how many denied people were eligible.
Why does the administration support the rules?
HHS and CMS leaders say community engagement promotes dignity, purpose, and connections to work and education, and that states can use the change to modernize Medicaid systems.
What should enrollees do now?
Update your contact information with your state Medicaid agency, read every notice, check exemption categories, keep proof of work or school hours, and ask a clinician about documenting serious health conditions.
Published by Medicaldaily.com
