The federal government released new guidance this week on how states should roll out the Medicaid work requirements that will affect  healthcare coverage for millions of Americans.

The new interim rule, issued by the federal Centers for Medicare & Medicaid Services, is intended to give states more details on how they’re supposed to verify the work status for about 20 million adults enrolled in Medicaid, the publicly funded health insurance program for people with low incomes.

The new details come as states are staring down the January 1, 2027, deadline to put the new work requirements in place, and have requested more clarity from the feds on how they’re supposed to implement them.

“States are being asked to carry out a complicated federal mandate without clear rules, without enough time, and with the risk that eligible people lose health care because of paperwork problems and system failures,” Oregon Democratic Gov. Tina Kotek said last week in a statement.

Kotek led a six-state coalition of Democratic governors in asking the Trump administration last week to slow the rollout of the new work requirements, calling the timeline unworkable.

Congress built the new work requirements into last year’s so-called One Big Beautiful Bill Act. Under the measure, states that have expanded Medicaid eligibility to more adults under the Affordable Care Act — 40 states plus the District of Columbia and another two that have partially expanded — will have to require those adults to prove they’re working, going to school or serving their communities for at least 80 hours a month to receive Medicaid.

The rules released this week are intended to clarify key parts of the new law, including exemptions for people who are considered “medically frail,” how to reach out to Medicaid beneficiaries, and methods for verifying Medicaid eligibility.

“This rule helps Americans build skills and independence through work, education, job training, or community service, creating new opportunities for themselves and their families,” said Dr. Mehmet Oz, director for the Centers for Medicare & Medicaid Services, in a statement announcing the new guidance.

But critics of work requirements point to evidence that it kicks people off Medicaid who are otherwise entitled to it without meaningfully increasing the share of adults who are working.

For example, Arkansas tried instituting work requirements for Medicaid recipients during Trump’s first term in 2018. By the time a federal judge halted the policy less than a year later, 18,000 adults had already lost coverage and reported problems paying off medical debt, delaying healthcare and delaying medications due to cost. Studies later found that Arkansas’ work requirements didn’t increase employment. And data shows that most adults on Medicaid under age 65 are already working.

Supporters say the new requirements are flexible. They say the feds have created a broad category of “medically frail” people who are exempt from the work requirements, and they’re permitting states to allow people to self-attest that they’re exempt one time before documentation is required.

The new work requirements will apply to about 20 million people who are eligible for Medicaid through expansion, according to estimates from health research organization KFF. These expansion enrollees make up about 30% of all Medicaid enrollees.

A recent analysis from the Urban Institute projects that 3-7 million people could lose coverage because of the new work requirements.

Stateline reporter Anna Claire Vollers can be reached at avollers@stateline.org.