A Medicaid rule change to work requirements means 140,000 Missourians with serious and chronic health conditions could struggle to qualify for healthcare coverage.
While Congress exempted medically frail people from the new Medicaid work requirements in the One Big Beautiful Bill Act, the interim rule requires individuals to prove not only the severity of the condition but also that it significantly impairs their ability to work.
Kansas City-based Legal Aid of Western Missouri is co-counsel in a lawsuit challenging the federal change. Executive Director Amber Christ described the definition of medically frail as “narrow.”
“Our clients won't lose coverage because they don't qualify for Medicaid or for the exemption,” she said. “They'll lose it because a form didn't get turned in, a deadline passed, or in some situations, a doctor couldn't produce records fast enough that the rule is now demanding from them.”
Under the act, adults who receive coverage through Medicaid expansion must demonstrate they have completed a specified number of hours to obtain or maintain coverage. It does not require verification of the condition’s severity in relation to ability to work.
The lawsuit argues that because this additional verification is not in the statute, it is overly punitive toward people who may fall short of that redefined scope of medically frail but otherwise qualify.
At particular risk are patients with disabling mental health conditions, cancer, diabetes and complex medical conditions requiring continuous access to treatment. In these cases, losing access to healthcare could mean missing needed appointments and medication, making it harder to work and regain coverage.
Emily Byrd, a 25-year-old Missouri resident, plaintiff in the lawsuit and Legal Aid of Western Missouri client, has several diagnosed conditions, including autism, obsessive-compulsive disorder, post-traumatic stress disorder, social anxiety and social phobia. Byrd, who lives in a transitional program, relies on Medicaid to cover supported housing, community support services, individual counseling, psychiatric evaluations and medication management.
Twice, Byrd has lost coverage — both times due to administrative issues, such as duplicate letters. Byrd has worked in the past and is not currently employed.
Byrd qualifies under the Medicaid Act as medically frail but may not meet the burden of proof required to prove the conditions significantly impair the ability to meet work requirements.
“It’s putting in place a new test with its own definition of disability, a new standard of proof that no one right now knows how to pass, and so it's going to have the impact of stripping coverage away from people who need it the very most,” Christ said.
Byrd is one of 12 listed plaintiffs in the case; others include the American College of Physicians, American Academy of Pediatrics, Society for Adolescent Health and Medicine, and Doctors for America. The U.S. Department of Health and Human Services, Secretary Robert F. Kennedy Jr., the Centers for Medicare and Medicaid Services, and CMS administrator Mehmet Oz are defendants.
The provisions in question go into effect on Jan. 1, so advocates hope the legal process will move fast enough to block them before then.
Jan Carney, president of the American College of Physicians, said the policy change would not help people get back to work; in fact, it would hinder doctors' ability to do their jobs.
“As physicians, we are trained to diagnose and treat our patients’ medical conditions, not to conduct assessments about a given patient’s ability to work,” Carney said in a statement. “Forcing doctors into the position of making these assessments diverts their time away from providing needed and life-saving health care to patients.”
