WASHINGTON — The Centers for Medicare & Medicaid Services on June 1, 2026, issued an interim final rule requiring certain adult Medicaid beneficiaries to complete 80 hours of work or qualifying activities each month to maintain coverage, drawing warnings from home care organizations and health policy researchers who say the policy threatens both the people who depend on home care services and the workers who provide them.
The rule — mandated under the One Big Beautiful Bill Act, the budget reconciliation legislation enacted in 2025 — applies to non-pregnant adults ages 19 through 64 who are not enrolled in Medicare and participate in Medicaid’s Affordable Care Act expansion population. The rule takes effect July 31, 2026, with states required to implement by January 1, 2027. Individuals who fail to demonstrate compliance receive a 30-day notice period before potential disenrollment.
Qualifying activities include employment, participation in a work program or job training, half-time enrollment in an educational program, or community service.
Industry Warns of Dual Impact on Workers and Recipients
Home care organizations and health policy researchers have identified direct care workers as particularly vulnerable to compliance difficulties. According to a May 2026 report by the Paraprofessional Healthcare Institute (PHI), approximately one-third of the nation’s 5.4 million direct care workers — roughly 1.8 million people — rely on Medicaid for their own health coverage.
PHI warned that home care workers face heightened barriers to demonstrating compliance with the 80-hour requirement, citing irregular work schedules, high rates of client turnover, and family caregiving responsibilities of their own. If a client dies or is hospitalized, a worker’s hours can drop abruptly.
“Destabilizing this workforce will have ripple effects across the long-term services and supports system, the broader health care system, the labor market, and state economies overall,” PHI stated in its report.
The AARP Public Policy Institute reported that 7.3 million family caregivers ages 18 through 64 receive Medicaid coverage for their own health insurance. The organization cautioned that “loss of Medicaid coverage can exacerbate the challenges family caregivers face and weaken the overall long-term care system by reducing their capacity to provide care.”
A 2026 industry survey found that 45 percent of home care leaders said Medicaid policy changes would have a “very large or huge impact” on their ability to scale operations. The Medicaid Home Care Chartbook 2026 projected that work requirements would reduce by 311,879 the number of Medicaid enrollees receiving home care services.
CMS Projects Large Coverage Reductions
The Congressional Budget Office projects the rule will result in more than five million people losing Medicaid coverage over time, with an estimated 2.3 million disenrollments in 2027 and 3.1 to 3.3 million annually in subsequent years — approximately 15 percent of the ACA Medicaid expansion population. CMS projects $391.9 billion in total Medicaid spending reductions over 10 years.
CMS Administrator Dr. Mehmet Oz said the agency would strictly enforce the self-attestation provisions. “We are serious about the consequences of dishonesty,” Dr. Oz said in remarks accompanying the rule.
Medicaid Director Dan Brillman said CMS intends to support states through the transition. “We want the path of this process to be smooth and seamless, and CMS is using and leveraging its power to convey,” Brillman said.
CMS announced $200 million in Government Efficiency Grants for fiscal year 2026 to help states build the technology and data-sharing infrastructure needed to verify compliance. At least two states — Nebraska and Montana — are already moving to implement enforcement ahead of the federal deadline.
Exemptions and Verification Process
The rule preserves exemptions for pregnant and postpartum women, individuals with disabilities or who are medically frail, parents or caregivers of children age 13 and under, former foster youth, American Indians and Alaska Natives, disabled veterans, and recipients of Temporary Assistance for Needy Families or Supplemental Nutrition Assistance Program benefits.
Under the verification process, states will first cross-reference existing claims data without requiring beneficiary action. Where data is unavailable, states may request documentation. Self-attestation will be permitted once during the first year of implementation; beginning in 2028, documentation will be required. Beginning December 31, 2026, states must also redetermine the eligibility of ACA expansion enrollees every six months rather than annually.
Anthony Wright of the advocacy organization Families USA said the rule “significantly raises the barrier for demonstrating medical frailty.”
Congressional Critics Call for Reversal
Congressional critics urged the administration to reconsider. Rep. Frank Pallone (D-NJ) called on CMS to withdraw the rule. Sen. Ron Wyden (D-OR) called the measure a “grim step.” Medical groups warned of widespread improper disenrollments, and patient advocacy organizations argued that beneficiary protections in the rule are inadequate.
Lisa Lacasse, president of the American Cancer Society Cancer Action Network, said cancer patients “will have to choose between losing…coverage, working…80 hours per month, or giving up working altogether.”
Background
Medicaid work requirements have been debated at the federal and state level for more than a decade. During the first Trump administration, several states received Section 1115 waiver approvals to implement work requirements, but federal courts blocked most of those programs. The Budget Reconciliation Act of 2025 bypassed the waiver process by codifying work requirements into statute as a mandatory condition of federal Medicaid matching funds for expansion states, eliminating the judicial avenue that previously halted similar efforts.
Why This Matters for Home Care
The populations most at risk under Medicaid work requirements — direct care workers, family caregivers, and adults with chronic illness relying on Medicaid coverage — overlap significantly with those who depend on home-based care. Policy-driven workforce disruptions and coverage losses can shift more of the daily caregiving burden onto family members who are already stretched.
For families navigating that added responsibility, the equipment in the home matters more than ever. SonderCare’s Aura bed line is designed to help family caregivers provide safe, effective care with less physical strain — featuring a FallSafe ultra-low platform at 10 inches to reduce fall risk during transfers, Trendelenburg and Zero Gravity positioning for clinical-grade comfort care, and a 500-pound weight capacity. For couples managing different care needs while staying in the same room, the Aura Companion Bed offers a split-king configuration that allows each side to operate independently.
If your household is facing increased caregiving demands, explore SonderCare’s home hospital beds at sondercare.com/beds or speak with a care specialist who can help identify the right configuration for your situation.
Sources: Home Health Care News (June 2026); Healthcare Dive (June 2026); Paraprofessional Healthcare Institute, “Medicaid Work Requirements: State Options and Implications for the Direct Care Workforce” (May 7, 2026); AARP Public Policy Institute, “Medicaid Work Requirements: Protecting Family Caregivers” (2025); CMS Interim Final Rule CMS-2454-IFC (June 1, 2026); HME Business (June 2026)
