Defending Medicaid
From the beginning as H.R. 1 was taking shape, our Defending Medicaid page has served as a hub of advocacy resources for state and national partners, providing context to the critical need that Medicaid serves and the dire impacts of rushed cuts to the program. As states begin to implement the law in 2026, Families USA continues this work. Below, you will find featured resources and analyses along with ways to get involved and push back against H.R. 1’s cuts to health care access and coverage.
FEATURED RESOURCE
The Dissecting the Deepest Cuts series breaks down how H.R. 1 and the federal rules implementing it reshape Medicaid, from work requirements, six-month renewals and new cost sharing to limits on provider taxes, provider payments and retroactive coverage. Together, these changes would make it harder for people to get and stay covered, cut the funding states use to run Medicaid and pay providers, and pile on unnecessary paperwork. In most areas, CMS has gone, or proposes to go, further than Congress required. The series also outlines how advocates can push states to use every protection the law still allows and document the harm as it unfolds.
What’s at Stake
Tell Congress: Uphold Your Promise and Protect Medicaid!
The policies in H.R. 1, like work reporting requirements, are harmful, costly, and ineffective — the damage should be reversed by ultimately repealing the bill. But right now, Congress must take immediate action to mitigate coverage losses and uphold their promises to protect disabled people, seniors, and all Americans who depend on Medicaid to meet their basic health care needs.
Tell Congress: Uphold your promise and protect Medicaid!
What’s Happening Now
Work Reporting Requirements
Among the many provisions in H.R. 1 that gut Medicaid, one of the most consequential is work reporting requirements (also known as “community engagement” requirements) to be implemented by January 2027. H.R. 1 requires applicants and enrollees aged 19–64 covered by Medicaid expansion to document they work or participate in “community engagement” activities for at least 80 hours per month, or that they qualify for an exemption (such as having a serious medical condition or being a full-time caregiver).
The burden of additional paperwork to prove hours worked or various exemptions makes it much harder for working adults, caregivers, and people with disabilities to maintain their Medicaid coverage. Families USA previously broke down why work reporting requirements are a solution in search of a problem, when at least 8 in 10 Medicaid enrollees would meet work or exemption criteria.
The significant paperwork burden of work reporting requirements along with more frequent eligibility checks means that at least three million and up to 10 million people will lose Medicaid coverage — not because they no longer meet the program’s requirements, but because they cannot jump through administrative hurdles and red tape.
In addition, states now have an enormous task ahead to: (1) set up new systems to determine eligibility and efficiently approve compliance or exemption within a compressed timeline and (2) conduct robust outreach to enrollees about policy changes and what individuals must do to remain covered.
The range of coverage loss in any state will depend on their implementation choices and how well each state can pull together new enrollment systems that adequately determine eligibility and keep vulnerable populations covered. Advocates can make the case for states to continue to learn from past states’ experiences, bolster the Medicaid program and its impact on the state’s health care system, and work closely with a wide range of stakeholders — including Medicaid enrollees and their families, hospitals, community health centers and other Medicaid providers, patient advocacy organizations — to learn about the real, ongoing impacts of implementation decisions.
Advocates Can Impact State Implementation Decisions to Ensure Eligible Populations Stay Enrolled
H.R. 1 offers states several key flexibilities to make operational choices that help reduce the complexity and burden of work reporting requirements, ultimately making it easier for eligible people to obtain and maintain coverage and the state to administer the program. These include:
- Requiring applicants and existing enrollees to show only one month of compliance at application/renewal
- Verifying compliance only at renewal rather than more frequently
- Allowing individuals to self-attest to work or exemptions where possible
- Implementing ex parte (automated) renewal systems
- Strategically engaging impacted communities
As states review federal guidance on work reporting requirements (released June 2026), states are making important implementation decisions now. For example, states are passing laws to require Medicaid applicants/enrollees to show three months of compliance, verify their compliance more frequently, and limit or prevent self-attestation. In addition, some states — including Nebraska, Montana, and Arkansas — are pushing forward implementation ahead of the already compressed timeline required by H.R. 1. If states rush implementation and make more punitive implementation decisions, Medicaid expansion-eligible communities will have to overcome significantly greater administrative hurdles to achieve and maintain coverage.
State advocates can help raise concerns with state Medicaid officials and other policymakers about rushed implementation and implementation choices that make the already burdensome work reporting requirement process even more challenging for eligible applicants and enrollees.
In addition, advocates can push back against work reporting requirements right now and through 2026, as early implementation begins and as all states head toward a January 2027 start date. We encourage advocates to build the following key moments in the implementation timeline into your advocacy campaigns and partner activations. You can also utilize the resources below, which will be updated throughout the upcoming months.
| Key Moment | Timing | Related Resources |
|---|---|---|
| State contracting and administrative decisions | Ongoing, through 2026 | Assessing the Medicaid Work Requirement Vendor Landscape, CBPP |
| Work Reporting Requirements Interim Final Rule with Comment (IFC) | Released June 1, 2026 | Send a message to Congress about state readiness, forthcoming |
| 1-year anniversary of H.R. 1 | Week of July 4, 2026 | |
| Notices sent to enrollees subject to work reporting requirements | Fall–Winter 2026 (varies by state) | |
| States may begin applying for good faith exemptions | Fall–Winter 2026 (varies by state) | |
| Work reporting requirements go live and enforcement begins in all states | January 1, 2027 | |
| First terminations begin in all states | March 2027 |
More Advocacy Resources
- Medicaid Work Reporting Requirements: Bureaucratic Burdens That Threaten Working Families, Providers and Local Economies, Families USA.
- A Guide to Reducing Coverage Losses Through Effective Implementation of Medicaid’s New Work Requirement, CBPP.
- Projected Reductions in Medicaid Expansion Enrollment Under OBBBA’s Work Requirements and Six-Month Redeterminations, Urban Institute.