AILSA CHANG, HOST:
A major way that the Trump administration paid for the president's priorities in the One Big Beautiful Bill last year was by cutting funding for Medicaid, specifically by requiring people to work or prove that they cannot work in order to receive coverage. This week, federal health officials released a document outlining the details of how that will function, and NPR's Selena Simmons-Duffin is here to explain. Hi, Selena.
SELENA SIMMONS-DUFFIN, BYLINE: Hi, AiIsa.
CHANG: OK. Let's start with the basics. Who exactly is affected by this?
SIMMONS-DUFFIN: Yeah. So Medicaid is a public health plan for low-income people. Its funding is split between the federal government and states, and it's really big. Sixty-eight million people across the country are currently enrolled. This new rule applies in the more than 40 states that expanded Medicaid under the Affordable Care Act, and it used to be that if you were under the income threshold, you could enroll in Medicaid and basically have free health insurance. When this takes effect in those expansion states, people as young as 19 and as old as 64 will have to prove to their state that they are working or medically unable to work every six months. If they can't do that, they'll lose their health coverage. Here's Dr. Mehmet Oz, administrator of the Center for Medicare and Medicaid Services (ph), defending the policy to reporters today at the White House.
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MEHMET OZ: If you're sitting at home, which is true for the millions of people who are on - who are able-bodied on Medicaid, on average, you're spending 6.1 hours watching television or just hanging around. That's not why you're here. So as a path to prosperity, Congress very wisely said, let's get you back into the workforce.
SIMMONS-DUFFIN: I should say, research shows that most people on Medicaid who can work do work because you can't really live off of health coverage...
CHANG: Right.
SIMMONS-DUFFIN: ...Which is why some advocates have called these rules paperwork requirements.
CHANG: OK. So you have been looking at the rule that Oz's agency released this week explaining the details of how all of this will operate. What exactly does this document say?
SIMMONS-DUFFIN: Well, it is very complicated. It's nearly 400 pages long.
CHANG: Wow.
SIMMONS-DUFFIN: And the timeline states have to take a look at this and get completely new systems up and running is by January. That's really challenging, according to Adrianna McIntyre of the Harvard T.H. Chan School of Public Health.
ADRIANNA MCINTYRE: It takes states literally months, usually years, to make the types of changes to their systems that they needed to make for this new rule.
SIMMONS-DUFFIN: That is not all, though. What was in this document makes the challenge for states even more difficult. So for months, federal health officials have been meeting with states informally and giving them guidance, and states understood that people with conditions where continuous coverage was really important would be exempt.
MCINTYRE: What the rule says is that the disease needs to be actively interfering with your ability to work. So people with early-stage cancer who are in radiation treatment but still have the capacity to work or people who have HIV but can still technically work are not exempted.
CHANG: Wow. OK. Well, then what's been the reaction so far to the rule?
SIMMONS-DUFFIN: Well, there is one conservative group, the Paragon Health Institute, that wrote in a statement, the rule, quote, "strikes the appropriate balance between necessary program integrity protections and accommodations for those who genuinely need assistance." Advocates for patients pretty uniformly panned the rule. Here's Carl Schmid, executive director of the HIV and Hepatitis Policy Institute, who has been lobbying for months for people living with HIV to have a blanket exemption, to no avail.
CARL SCHMID: We're just going to lose people to Medicaid, and then they're going to get sick, and then they're going to die. And so, yeah, I'm upset.
SIMMONS-DUFFIN: He says they're not going to give up. They're going to file a comment and start lobbying state to state to try to get exemptions, and he thinks there will be lawsuits filed as well.
CHANG: That is NPR's Selena Simmons-Duffin. Thank you so much, Selena.
SIMMONS-DUFFIN: You're welcome. Transcript provided by NPR, Copyright NPR.
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