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June 11, 2026
The Boost News
We’re coming up on a full year since H.R. 1 (President Trump’s “Big Beautiful Bill Act”) was signed into law on July 4, 2025. Included in the bill was nearly $1 trillion in cuts to Medicaid, a program jointly funded by states and the federal government. The bill also conditioned Medicaid eligibility for some adults in the Affordable Care Act Medicaid expansion group (and the two states in partial expansion waiver programs) on meeting work, or community engagement, requirements starting Jan. 1, 2027.
Then, on June 1 of this year, the Centers for Medicaid and Medicare released an Interim Final Rule (IFR) that will guide implementation of those requirements and its “medically frail” exemptions. The rule adopts a far more restrictive, and still to be untangled, definition of medical frailty than states had been expecting. (KFF’s CMS Requires More Restrictive Definition of Medical Frailty in New Medicaid Work Requirements Rule is a good primer on the changes.)
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