Cancer and HIV patients face Medicaid risk under new work rules

Advocates and medical groups warn that strict Medicaid work requirements released by the Trump administration will jeopardize coverage for 68 million low-income Americans, including people with cancer and HIV, by January 1 in participating states. They argue t

In the White House briefing room on Tuesday, Dr. Mehmet Oz laid out new Medicaid work rules meant to push low-income adults toward employment. The promise—“a path to prosperity”—was delivered alongside a message that Congress “very wisely said” it was time to “get you back into the workforce.”

But in the same remarks. and in the interim final rule released Monday. advocates heard something else: a timeline that compresses state implementation. a definition of exemptions they say is too narrow for serious illness. and a looming risk that people with cancer and HIV—those already navigating treatment—could lose coverage just as they need it most.

At stake is health coverage for 68 million low-income Americans on Medicaid. the health insurance system jointly funded by states and the federal government. States must put the work requirements into effect by January 1. a deadline that one health policy expert said is already unrealistic. Adrianna McIntyre, assistant professor of health policy at the Harvard T.H. Chan School of Public Health. said states typically take months—“usually years”—to make the system changes needed to implement a new rule. She added that officials were “severely constrained” by the timeline having “a year and a half from the time of the law being passed to implement all of this.”.

The interim final rule is nearly 400 pages long. And McIntyre said that for months. federal officials met informally with states and gave guidance that suggested people with conditions where continuous coverage mattered would be exempt. “What the rule says, as published, is that that’s actually not enough,” she explained. Under the rule, she said, a condition has to be actively interfering with a person’s ability to work. She pointed to scenarios like early-stage cancer in radiation treatment: even if a patient is undergoing care. if they still have the capacity to work. she said. they would not be exempt. The same logic would apply, she said, to people with HIV who can technically work.

McIntyre described how that could translate into sudden loss of coverage. She expects cases where a person newly diagnosed with cancer—and working—could lose Medicaid because they do not fill out the paperwork correctly. The consequence, she said, would be losing coverage when treatment demands are highest.

The work requirements are rooted in a broader Medicaid overhaul tied to a budget law. Republicans passed the new rules in their big budget bill that President Trump signed on July 4. 2025. passing without any Democratic support. The law included major cuts to Medicaid to fund Trump’s policy priorities. including tax cuts and the crackdown on immigration. The work requirements are part of a $900 billion cut to Medicaid. and they are designed to limit who can be on government health insurance. The Congressional Budget Office estimated that about a third of that $900 billion cut comes from the work requirements. CBO also said 5 million people will lose Medicaid coverage.

Dr. Oz argued the policy was designed to return people to work. In Tuesday’s briefing. he said that if someone is “sitting at home” on Medicaid. “on average. ” they are spending “6.1 hours watching television. or just hanging around.” He framed it as a congressional directive to return people to the workforce.

A conservative group closely aligned with the Trump administration, the Paragon Health Institute, backed the approach. In a statement, it said the rule “strikes the appropriate balance between necessary program integrity protections and accommodations for those who genuinely need assistance.”

Under the new requirements. which apply in the more than 40 states that expanded Medicaid under the Affordable Care Act. adults from age 19 to 64 will need to periodically prove they are working. going to school. or volunteering at least 80 hours a month. Alternatively, they will have to prove they are exempt from the work requirement. The policy starts in January, and McIntyre said states are only beginning to confront what that means in practice.

Many on Medicaid already meet the standard, KFF found in an analysis of government data. About 1 in 5 people are not meeting the 80 hours-per-month threshold. according to KFF. and that group has barriers that keep them from the workforce. Some cannot find jobs; others were laid off; others have retired.

Medical groups and advocates reacted with uniform sharpness. A coalition of 48 patient organizations issued a joint statement saying the interim final rule “does not protect people with serious or complex health conditions” and would “dramatically and inappropriately” increase the number of people who lose healthcare coverage.

For people living with HIV, the fight is personal and immediate. Carl Schmid. executive director of the HIV + Hepatitis Policy Institute. said his group had lobbied for months for a blanket exemption for people living with HIV. without success. “We’re just going to lose people to Medicaid and then they’re going to get sick and then they’re going to die. ” Schmid said. “So, yeah, I’m upset.”.

He said his group will file comments on the final rule and begin lobbying state by state to seek exemptions. He expects lawsuits as well. Comments on the interim final rule are open until July, and the government has the option to make changes or not.

The American Academy of Pediatrics also urged a change, warning the rule could harm families. Dr. Andrew D. Racine. the president of the AAP. wrote in a statement that the “new burdensome requirements” faced by many parents would “ultimately undermine families’ health and financial stability.” He said narrowly defining who qualifies for exemptions could add to state costs to administer the program. create “headaches” for families navigating bureaucracy. and harm the people Medicaid is meant to serve.

Critics also argue the federal policy does not come with support that helps people meet work demands. Jennifer Wagner. who analyzes Medicaid eligibility and enrollment at the left-leaning Center on Budget and Policy Priorities. said there is “no funding here to help people find or keep work. ” unlike other public programs with work requirements. such as food assistance. “That just implies or suggests that somebody could get a job if they wanted — they just need a little shove. ” Wagner said. She described it as evidence of a “complete lack of understanding of what people are actually going through.”.

Wagner said the complexity of the federal requirements could produce chaos and confusion. “We know from past experience in Medicaid and other programs that it’s usually the eligible people who lose coverage because of the work requirement. ” she said. Even if someone has an exemption “on paper. ” or is compliant “technically. ” she said. reporting it—and understanding what needs to be done—can fail in real life: filling out the right paperwork. providing verification when required. and meeting administrative demands. “There’s so much that can go wrong in that process that often leads to eligible people losing coverage,” she said.

Some Republican-led states are launching the requirement early, but most are expected to begin by January 1.

The pressure now falls on state systems that. by McIntyre’s count. may not have enough time to make. test. and launch the changes needed—while patients and advocates press for exemptions that match the realities of illness and treatment. For people like Schmid’s members, the argument is not abstract. It is about what happens when the paperwork meets a diagnosis. and whether coverage disappears at the moment care is most urgent.

Medicaid work requirements Dr. Mehmet Oz Centers for Medicare and Medicaid Services interim final rule January 1 HIV cancer exemption Congressional Budget Office KFF Trump administration