The Trump administration’s rollout of a federal mandate that millions of Americans on Medicaid must work or risk losing health benefits will force states to scrap months of preparation, according to advocates for Medicaid enrollees and consultants advising states.

And they say an overhaul — less than seven months before states must start enforcing the requirement — will be costly.

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An Albanian man’s pain grew so unbearable, he said, he pulled out his own tooth as he languished for months in a New Mexico immigration detention center. A Honduran mother of two said she was hospitalized for a heart problem after she was denied blood pressure medications while held in Florida. A Venezuelan man said his leg grew purple and swollen from flesh-eating bacteria when staffers at a Vermont facility did not bring him to a scheduled doctor appointment.

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On June 1, 2026, the Centers for Medicare and Medicaid Services (CMS) issued a long-anticipated interim final rule that will guide state implementation of Medicaid work requirements. The 2025 reconciliation law requires 43 states to condition Medicaid eligibility for adults in the Affordable Care Act (ACA) Medicaid expansion group and enrollees in partial expansion waiver programs (Georgia and Wisconsin) on meeting work requirements starting January 1, 2027 or sooner at state option. Most Medicaid adults are already working or face barriers to work, and the Congressional Budget Office estimates that the new requirements will not meaningfully increase employment by Medicaid enrollees, but that millions of people will end up uninsured.

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About this Episode

Episode 6, AI Series: Is AI Better for patients? What is changing on the ground? Chip talks with Dr. Patrick Conway, Chief Executive Officer of Optum, a health services and technology business under parent company, UnitedHealth Group. They discuss how to ensure the health care industry’s use of AI serves patients first, particularly when the same company bears financial risk and builds the AI that decides who gets care. They also discuss whether use of AI can make value-based care the dominant payment framework, after two decades of policymaker support for the model.

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SOCIAL CIRCLE, Ga. — Until recently, this rural city about 45 minutes east of Atlanta was best known for its Blue Willow Inn cookbooks featuring recipes for Southern dishes such as baked pineapple casserole and kudzu blossom jelly.

Lately, however, the community has been trying to stave off a new identity of “prison town” as it fights the opening of what could become the nation’s largest immigration detention center, holding up to 10,000 people.

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GRAND JUNCTION, Colo. — Two state transportation workers were replacing a sign on the shoulder of U.S. Highway 6 in western Colorado one morning when a Jeep Grand Cherokee swerved off the road and struck them.

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James Mu had braced for the call that came in late January.

A patient from his rural Northern California county had measles, a disease so rare there that many physicians have never treated a case.

While California has some of the strictest vaccine laws in the country, conservative Shasta County’s approach during the covid pandemic stood in stark contrast with the state’s guidance. Its local leaders opposed masking and vaccine mandates, and they ousted the county public health officer, who had sought to enforce those state policies and other safety measures.

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Highlights

A hantavirus outbreak linked to a Dutch cruise ship in early May was followed by false health claims that mirror patterns documented in previous outbreaks, including unsupported claims that ivermectin is an effective treatment, that the outbreak was planned in advance, and that it was caused by COVID-19 vaccines.

The Monitor also examines a new analysis of Americans’ relationship with health and wellness influencers, finding that most who get health information and advice from them express skepticism about what they hear.

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The Average Medicare Advantage In-Network Limit is $5,421 in 2026, But Nearly 1 in 5 Enrollees Face In-Network Limits Higher Than $7,000

For coverage of Medicare benefits, people face a choice between traditional Medicare and private Medicare Advantage plans. While there are many distinguishing features between these coverage types, one key benefit of Medicare Advantage is an annual cap on out-of-pocket costs for medical benefits, which traditional Medicare does not include. In 2026, the out-of-pocket limit for Medicare Advantage plans may not exceed $9,250 for in-network services and $13,900 for a combination of in-network and out-of-network services, but plans can have lower out-of-pocket limits than the maximum.

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The 2025 reconciliation law requires states to condition Medicaid eligibility for adults in the Affordable Care Act (ACA) Medicaid expansion group and enrollees in partial expansion waiver programs (Georgia and Wisconsin) on meeting work requirements starting January 1, 2027 or sooner at state option. The law specifies mandatory exemptions, including individuals who are “medically frail.” To ease the burden on individuals, the law directs states to use available information “where possible” to verify compliance with Medicaid work activities or exemption status, without requiring additional documentation from individuals. Given the abbreviated implementation timeline, states are moving forward with key decisions over how to implement the medical frailty exemption even as they wait for formal guidance from the Centers for Medicaid and Medicare Services (CMS), which is required to issue an interim final rule by June 1, 2026. This brief describes early state plans to operationalize the medical frailty exemption and identifies key issues that they are facing and may be answered in the forthcoming guidance.

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