A recent policy change is raising concerns about access to Medicaid coverage for millions of low-income Americans, particularly those managing serious health conditions. The One Big Beautiful Bill Act, enacted in July 2025, introduced new work requirements for Medicaid eligibility, which critics argue may jeopardize health care access for vulnerable populations.
The legislation extended tax cuts that primarily benefit higher-income individuals, while simultaneously mandating that Medicaid recipients in states that expanded coverage under the Affordable Care Act must document at least 80 hours per month of work, volunteering, education, or related activities to maintain their benefits by the end of 2026. This change affects approximately 40 states and the District of Columbia.
Medicaid currently covers more than 68 million low-income individuals across the United States, including women, children, people of color, individuals with disabilities, and older adults. According to the American Cancer Society, 10% of adults with a history of cancer rely on Medicaid. The Urban Institute estimates that between 4.9 million and 10.1 million people nationwide could lose coverage by 2028 as a result of these new requirements.
Personal stories underscore the human impact of these policy changes. A New York resident and Medicaid enrollee, diagnosed with breast cancer in August 2025, exemplifies the challenges faced by many. Having immigrated to the U.S. in 2004 and worked as a service worker, she underwent mastectomy and reconstructive surgeries and is currently engaged in physical therapy to regain upper body mobility. The physical demands of her previous job, combined with ongoing recovery, make it difficult for her to meet the new work or volunteering hours required to maintain Medicaid eligibility.
While the legislation includes exemptions for individuals with physical, intellectual, or developmental disabilities and those considered medically frail or with complex medical conditions, federal guidance issued in June 2026 delegates to states the authority to define specific medical conditions qualifying for exemptions. This guidance narrows the criteria and requires medical professionals to document how illnesses, such as cancer, limit a patient’s ability to fulfill work or community engagement requirements. States like New York must also update diagnosis codes to reflect these severity assessments.
Advocates argue that the regulations risk excluding people who genuinely cannot meet the work mandates due to medical or other barriers. They emphasize the necessity of clear, inclusive definitions to safeguard access for those most in need. Medicaid proponents highlight the program’s vital role in providing affordable health care and maintaining quality of life for millions.
Opponents of the work requirements contend that encouraging employment and engagement is essential to long-term self-sufficiency, while supporters say the policy helps ensure the sustainability of Medicaid funding.
As states begin implementing these guidelines, the balance between promoting work and protecting vulnerable populations remains a contentious issue, with significant implications for the health and stability of many families across the country.