A new rule issued by the Centers for Medicare and Medicaid Services (CMS) this month adopts a restrictive definition of “medical frailty” when implementing Medicaid work requirements. This will make it much harder for sick, low-income patients, including breast cancer patients, to maintain their critically necessary health care.
As a result of last year’s “One Big Beautiful Bill Act,” beginning in 2027, individuals in the Medicaid expansion population must work or volunteer at least 80 hours per month, attend school at least part-time, or participate in job training to keep their benefits. Eligibility for exemption due to “medical frailty” will be largely left up to states, resulting in inconsistency from state to state and widespread confusion for patients.
The Congressional Budget Office estimates these new requirements will cause millions of individuals to lose their health care coverage, without meaningfully increasing Medicaid enrollee employment as the rule intends
NBCC is deeply concerned that narrowing the definition of “medical frailty” will create significant barriers to accessing care for people with serious medical conditions like breast cancer. Under current law, those with strictly defined serious medical conditions are automatically exempt from work requirements. Now, these patients will have to take extra steps to prove that they’re sick enough to qualify for Medicaid; this will unnecessarily put an already vulnerable population at even greater risk.
