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The Trump administration’s appetite for cruelty and its wanton disregard for wasting taxpayer funds has shown itself again — this time in its proposed regulations for implementing the One Big Beautiful Bill Act’s (OBBBA) Medicaid eligibility requirements. But as new details emerge, there are some possible ways that states could protect eligible populations from losing health care.

The proposed regulations, which were officially released on June 3, require many individuals with serious illnesses or medically complex situations to prove they are unable to meet work requirements. This upends months of guidance to states from an agency of the Department of Health and Human Services that has informed the tens of millions of dollars they have already spent building information systems to collect and confirm individuals’ eligibility for Medicaid in time for the January 1, 2027 start date of the new regulations.

Based on advice from administration officials, state health departments hired staff, upgraded technology and developed systems to manage eligibility to determine which individuals are working and which will have work requirements waived based on their medical condition. But those efforts will now be superseded by the nearly 400-page long proposed regulations, and information systems will have to be reconfigured to conform to the changes. It should be noted that there is something deeply ironic about an administration that professes an aversion to bureaucracy releasing a 400-page proposal that gives states guidance on how to oversee new bureaucratic systems.

Defining “Medically Frail”

The Trump administration’s work requirements for disabled, near-poor individuals to qualify for Medicaid go well beyond what the OBBBA requires. Many seriously ill individuals or those with medically complex situations will be required to prove they are too disabled to work — a Catch-22 proposition for a population that may be too physically compromised to comply. In a 387-page advance document, the proposed rule explicitly removes from the category of medically frail individuals those undergoing treatment for cancer or who have been diagnosed with end stage renal disease. They, along with many others with debilitating conditions, will need to show that they are, indeed, medically frail and unable to work in order to have the work requirement waived.

The Affordable Care Act expanded Medicaid’s coverage of low-income people by raising the income threshold for eligibility to 138 percent........

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