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New Medicaid work requirements illustrate how 'law is a determinant of health for patients and physicians alike'

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New Medicaid work requirements illustrate how 'law is a determinant of health for patients and physicians alike'

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Beginning in January 2027, millions of low-income adults with Medicaid coverage will be required to document at least 80 hours of employment, job training, volunteering or education each month to maintain their insurance coverage.

Since these new "community engagement" requirements passed in the One Big Beautiful Bill Act (H.R.1) in July 2025, health and policy experts have sounded the alarm on the significant administrative burdens these requirements will place on Medicaid recipients and states alike, which could result in up to 10 million people losing their insurance coverage.

These new conditions for Medicaid eligibility may also pose grave challenges for physicians and the practice of medicine as a whole, according to a new perspective by Boston University School of Public Health (BUSPH) researchers in the New England Journal of Medicine.

Physicians will be expected to adhere to new rules for determining and documenting Medicaid enrollees who are exempt or excluded from these requirements, including people who are "medically frail" and deemed to have certain limitations impacting their ability to work.

These new rules will create an unprecedented task for health care providers marked by extensive paperwork, pressure on states to not be too generous with exemptions, and likely worsening health for patients losing coverage and unable to access care, write Nicole Huberfeld, Edward R. Utley professor of health law at BUSPH and Boston University School of Law, and Dr.


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