{"id":538,"date":"2026-07-31T09:37:17","date_gmt":"2026-07-31T09:37:17","guid":{"rendered":"https:\/\/frontierhousingreport.com\/?p=538"},"modified":"2026-07-31T09:37:17","modified_gmt":"2026-07-31T09:37:17","slug":"trump-to-hiv-and-cancer-patients-get-back-to-work","status":"publish","type":"post","link":"https:\/\/frontierhousingreport.com\/?p=538","title":{"rendered":"Trump to HIV and Cancer Patients: Get Back to Work"},"content":{"rendered":"
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This piece is part of our Trump\u2019s Beautiful Disaster series about the consequences of the mammoth budget law, one year later. You can see all stories in this series <\/em>here<\/em>.<\/em><\/p>\n

Read more Hot Centrist Summer Was a Bust<\/a><\/p>\n

Yesterday was the 61st anniversary of the signing of Medicare and Medicaid, a promise by the government to at least care for the oldest and most vulnerable people in our society. Today is the deadline for public comment on a rule that could force severely ill patients with cancer, HIV, and other ailments to get out of their hospital beds and go to work if they want the government to keep that promise.<\/p>\n

The , which was spurred by cuts to Medicaid in the One Big Beautiful Bill Act (OBBBA) but was not required in the text, adds a layer of bureaucracy for \u201cmedically frail\u201d individuals who got a statutory exemption from the law\u2019s new work requirements for health coverage. Medical frailty has long been a concept in Medicaid, giving patients suffering from serious conditions the ability to access coverage. But the administration\u2019s interim final rule published last month said that not only would individuals have to exhibit one of the medically frail conditions, but their condition would have to \u201csignificantly impair\u201d their ability to work.<\/p>\n

\u201cThat\u2019s not an existing standard, and there\u2019s no data source for that information,\u201d said Jennifer Wagner with the Center on Budget and Policy Priorities (CBPP). This means that states, which are partners in Medicaid, will have to establish an entire regime for verifying \u201csignificant impairment\u201d on the fly, and justify it to a federal government that is quick to say that anything resembling expansion of assistance to the poor is actually fraud. \u201cThere\u2019s language in the [rule] that says \u2018we will hold states accountable\u2019 if they don\u2019t follow this unclear definition precisely,\u201d Wagner said.<\/p>\n

More from David Dayen<\/em><\/strong><\/p>\n

So people with serious medical maladies\u2014osteosarcoma patients suffering severe bone weakness, for instance\u2014will have to jump through very undefined bureaucratic hoops to \u201cprove\u201d they cannot work 80 hours a month, with the risk of a coverage loss if that\u2019s denied. Even a temporary coverage gap could be serious. \u201cThey will die, they will become sick,\u201d said Carl Schmid, executive director of the HIV+Hepatitis Policy Institute in Washington. \u201cThat\u2019s why we pushed so hard for the exemption, because we know the ramifications of people losing access to health care.\u201d<\/p>\n

Schmid cited estimates that 145,000 Americans living with HIV could be affected by the change. About 40 percent of all Americans with HIV rely on Medicaid, according to Schmid.<\/p>\n

Twenty-four states and two governors filed suit against the Centers for Medicare & Medicaid Services (CMS) over the rule change. District court judge Richard Stearns against the rule this week but promised an expedited briefing schedule that would address the merits of the case before it is implemented along with the work requirement deadline at the beginning of next year.<\/p>\n

AT ISSUE IS SECTION 71119 OF OBBBA<\/strong>, requiring that most Medicaid recipients work at least 80 hours a month or spend a similar amount of time in school, training, or volunteer work. This is the source of the largest amount of cuts to Medicaid in the law. CBPP estimates that as many as 36 million Medicaid enrollees will be affected by the new burden. The Congressional Budget Office has predicted that five million enrollees will lose coverage; the Urban Institute puts that number at seven million.<\/p>\n

Studies have shown that Medicaid work requirements do not increase overall work hours. The goal is simply to get enrollees tangled up in paperwork. \u201cTheir big ugly bill was designed to kick eligible people off of Medicaid to pay for tax cuts that benefit big corporations and special-interest donors,\u201d said Sen. Tammy Baldwin at a press event about the Medicaid changes.<\/p>\n

The law included an exemption for medically frail individuals and listed various categories defining that condition. The categories included blindness; substance abuse disorders; \u201cdisabling\u201d mental health disorders; physical, intellectual, or developmental disabilities that impair activities of daily living; and serious and complex medical conditions.<\/p>\n

But CMS had the job of creating the specific definition of medical frailty. For several months, its guidance to states was that it would be defined by conditions that would grow worse if people lost coverage. Republicans quoted during the debate over OBBBA said the same thing. That would be a simple process; pulling diagnostic codes that correspond to the exemption would be relatively automated.<\/p>\n

\u201cWhen we had meetings with this administration, they said, \u2018How did you fare in the past?\u2019 And we said we were exempt,\u201d said Schmid. \u201cThey came back and said, \u2018Can\u2019t they work?\u2019 I said they can work, many of them do. But they cannot lose access to their care and treatment, it\u2019s just that critical. What are you going to do, they lose coverage, then they get sick, and then they\u2019re eligible?\u201d<\/p>\n

But the effectively does just that. It requires medically frail patients to certify that they are too significantly impaired to comply with the work requirement. If they aren\u2019t sick enough, they would have to work or do some equivalent service.<\/p>\n

This will almost certainly reduce the number of people who get the exemption, even among those who are eligible for it. Work requirements in Medicaid have delivered poor results when tried, like in Georgia, where bureaucratic hurdles routinely interrupt coverage and where verification structures are expensive for the government to maintain. In Arkansas, 18,000 eligible enrollees lost coverage in the first couple of months of implementation of a work requirement in 2018, primarily because of paperwork burdens.<\/p>\n

When we\u2019re talking about health coverage, even slight gaps are a matter of life or death, because most people with special needs require continuous care.<\/p>\n

Read more The Great \u2018Made in the USA\u2019 Fraudyssey<\/a><\/p>\n

Alexander Lu is a Medicaid patient from Nebraska, made available on a press call by Caring Across Generations and other stakeholders. \u201cI officially started collecting diagnoses when I was 20,\u201d Lu said, citing multiple disorders and low vision, which eventually was determined to be caused by a brain tumor \u201cmaking my brain a pressure cooker.\u201d He will soon be legally blind.<\/p>\n

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Read: The Big Beautiful Bill\u2019s market-based health care delusion<\/strong><\/p>\n<\/blockquote>\n

\u201cPeople facing serious illness and disabilities should not have to prove they\u2019re working enough hours while undergoing surgery and recovery from a brain injury,\u201d Lu said on the call. \u201cThese funding cuts will kill people, I\u2019m literally living proof of that.\u201d<\/p>\n

Rebecca R., a Medicaid beneficiary and breast cancer survivor from Wisconsin, told her story as well. She\u2019s been through a gauntlet of care that\u2019s included surgeries, chemotherapy, and radiation. She\u2019s eager to return to her work as a paralegal, but future care needs would necessarily get in the way. \u201cI have another surgery ahead of me,\u201d she said. \u201cThere are appointments nearly every day, even through my post-recovery. I\u2019m trying to get back to work even though I\u2019m going to have to take off next year.\u201d<\/p>\n

That\u2019s the problem with the rule, advocates say; inconsistent work hours from one month to the next can get someone dropped from coverage.<\/p>\n

THE RULE WAS ISSUED JUNE 1<\/strong>, just seven months before the implementation deadline. States that already implemented work requirements\u2014as Nebraska did in May\u2014had to go back and redo their system after the rule was introduced. The state put out a list of diagnostic codes for medical frailty, but it\u2019s not clear that will be enough, since the new requirement is more individual than just having a particular disease or illness.<\/p>\n

No method was identified for how to handle the significant impairment requirement. In 2027, the first year of implementation, states can allow the medically frail to self-attest. But even that is different from an automated renewal, requiring forms that have to be filled out correctly, returned by a deadline, and processed.<\/p>\n

After that, documentation is required. And nobody knows what documentation. Is it a doctor\u2019s note? Would the patient need to supply medical records or insurance claim data to the government? Would pharmacy claims, usage of durable medical equipment, or frequent medical visits suffice? These are new and unclear burdens. \u201cStates don\u2019t have a ton of capacity,\u201d Wagner said. No additional money is given to the states to implement.<\/p>\n

The lawsuit from the states says that the significant impairment rule defies congressional intent. \u201cNowhere in H.R. 1 does Congress state that individuals\u2019 ability to work must be impaired in order to be \u2018medically frail or otherwise have special medical needs,\u2019 or to have a \u2018serious or complex medical condition,\u2019\u201d the complaint reads.<\/p>\n

For HIV patients affected by the rule, there is a fallback: the Ryan White HIV\/AIDS Program, which provides assistance with retroviral drugs. But that assistance program hasn\u2019t seen an increase in funding in 13 years, and if more people flood to use it, the fiscal crunch will be even sharper. \u201cRyan White is the payer of last resort, and it\u2019s already stretched,\u201d Schmid said.<\/p>\n

Over 20,000 comments have been received on the rule thus far, most of them against the change to the medical frailty requirements. Many show the dangers of interrupting continuous coverage for these populations. \u201cMy developmentally disabled daughter has already lost her Medicaid one time due to a form being missed and me having to sit on hold for literally 90 minutes and still not being helped,\u201d one commenter wrote. \u201cThe process is extremely complicated and needs to be streamlined not made worse.\u201d<\/p>\n

But it\u2019s unclear what the comments will actually do: The of the rule said the regulations would be effective on July 31, today.<\/p>\n

Republicans have consistently condemned the overly bureaucratic nature of the government over the years, but this hurdle is not only the epitome of the worst kind of Kafkaesque bureaucracy, it hits extremely vulnerable and stressed people, forcing them to juggle forms while their health and even their lives hang in the balance.<\/p>\n

\u201cIt\u2019s terrible in our country that we are seeking to deny health care to these people,\u201d said Schmid. \u201cIt\u2019s inhumane, I believe.\u201d<\/p>\n

Read more Abdul El-Sayed Lost in 2018. It Set Him Up for 2026.<\/a><\/p>\n<\/div>\n


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