High‑unemployment counties could shield millions from Medicaid work rule
President Trump's domestic policy law will require many nondisabled adult Medicaid enrollees in expansion states to work, volunteer or study 80 hours per month starting January 2027, but the statute allows county-level exemptions where unemployment is very high. A KFF analysis—cited by CBS News—shows that if the administration uses a one-month threshold roughly 4.6 million enrollees in 386 counties could be exempt today; using a stricter 12-month average would cut that to about 1.4 million in 158 counties, concentrated mainly in California, New York, Michigan, Kentucky and Ohio. The CBO projected the rule would apply to 18.5 million enrollees and cause about 5.3 million to lose coverage by 2034, though final scope depends on how the administration defines and grants county exemptions and whether states apply for them.
🔍 Key Facts
- Implementation date: January 2027 is the statutory start for many adult, nondisabled Medicaid enrollees to meet an 80-hour/month work or activity requirement
- CBO projection: 18.5 million Medicaid enrollees would be subject to the requirement; about 5.3 million could lose coverage by 2034
- KFF analysis: under a one-month unemployment threshold ~4.6 million enrollees in 386 counties could be exempt; under a 12-month average threshold ~1.4 million enrollees in 158 counties could be exempt
- Exemption thresholds: county unemployment ≥ 8% or ≥ 1.5 times the national unemployment rate
- Geographic concentration: ~90% of those exemptable under the 12-month standard are in California, New York, Michigan, Kentucky and Ohio