Where jobs are scarce, over 1 million people could dodge Trump’s Medicaid work rules

Millions of Medicaid registrants can have a way to get out of the new federal Work requirement – If they live in a county with high unemployment.

In January 2027, the law of large -scale national policy of President Trump will force many registered in non -disabled Medicaid in 42 states and Washington, DC, to work or volunteer for 80 hours per month or go to school.

But under the law, Medicaid enrolled in counties where unemployment is at least 8% or 1.5 times, the national unemployment rate could be protected from the work requirement, if their state requires an exemption.

A new KFF analysis shows that the exemption in the GOP work requirement could offer a stay to millions of Americans potentially taken in a difficult situation – needing to work to guarantee health insurance but to have trouble finding a job.

The Congressional Budget Office has provided that the work requirement would apply to 18.5 million MEDICAID registrants, which caused around 5.3 million people to lose in 2034. CBO spokesperson Caitlin Emma, ​​confirmed to Kff Health News that analysts took into account the exemption from the unemployment rate in their projections. Only the states which expanded Medicaid under the Act respecting affordable care of 2010 or a special derogation must adopt a work requirement, under federal law.

But how many people could be exempt depends on how the Trump administration interprets the law, in addition to knowing whether those responsible for their states apply.

For example, if Trump officials have exempted people in counties where the unemployment rate was higher than the thresholds of the law for a month over a period of 12 months, around 4.6 million registered medicaid in 386 counties could qualify for an exemption today based on the latest unemployment data, according to KFF, non -profit health information that includes Kff Health News.

This is equivalent to just under a quarter of all the registrants of Medicaid subject to the work requirement.

Within the framework of this one month threshold, “the impact could be quite significant,” said Jennifer Tolbert, co-author of the analysis and deputy director of the KFF program on Medicaid and not assured.

But, she said, the Trump administration is more likely to adopt a stricter threshold based on average unemployment over a period of 12 months. Which would align with the work requirements under the federal Additional nutrition assistance programfood assistance commonly called food coupons.

According to KFF, approximately 1.4 million MEDICAID registrations living in 158 counties could be exempt under this standard, or about 7% of the total work requirements subject to work requirements. This represents about 7% of the registrants that live in states of expansion which would otherwise need to meet the new requirement.

Based on the 12 -month criteria, around 90% of Medicaid registered which could be exempt on the basis of high unemployment resident in five states, according to KFF: California, New York, Michigan, Kentucky and Ohio. California alone represents more than half of those who could be exempt.

The exemption from the unemployment rate is one of the many discoveries of the Medicaid work requirement in the law of the GOP. The law also exempts parents with children under the age of 14, people with disabilities or fragile, and those who are pregnant, imprisoned or in a program of substance consumption disorders, among others. The high provision of unemployment is most of the most part, because it exempts people living in whole counties.

Two main Republicans for the adoption of the bill – the president of the Chamber Mike Johnson and Senator Mike Crapo, president of the Senate finance committee – did not respond to requests for comments.

To qualify for the medical exemption, states should apply to the federal government on behalf of people from eligible counties. And if a county gained an exemption, the government would determine how long it applies.

Even if the federal government grants largely exemptions, the defenders of health fear that certain states led by the Republicans can retreat to request exemptions in order to maintain registration, because they say that this was the case with SNAP exemptions. In 2023, 18 states had no exemption as part of the Snap program, even if some of their residents could be eligible.

“This is not a guarantee that people can count on,” said Emily Beauregard, executive director of Kentucky Voices for Health, a plea group who intends to put pressure for the widest possible exemptions to help people maintain their coverage. Eastern Kentucky has several counties with eternally high unemployment.

By pleading for Trump’s billMany Washington Republicans have argued that most people who have acquired Medicaid benefits under the affordable care law should work to get rid of government aid.

But as the experiences of Georgia and Arkansas have shown it, the work requirements of Medicaid can be costly for states to be managed and frustrating so that registrants can navigate. About 18,000 people in Arkansas, almost a quarter of state adults, who have acquired Medicaid coverage thanks to the expansion of the ACA, lost coverage when the state had a work requirement in 2018 and 2019. A court ended the State’s work obligation program.

Critics point out that most of Medicadaid registrants are already working or have disability or care provision, and they argue that the declaration requirements only serve the bureaucratic obstacle to obtain and maintain coverage. Under the law of the GOP, the work status of the registrants must be verified at least twice a year.

Most coverage losses due to work requirements occur in people who work or should be eligible for an exemption but nevertheless lose coverage due to administrative formalities, according to research.

Not all states should implement a work requirement under the law of Mr. Trump, only those who have chosen to extend the coverage of Medicaid to more with low -income people through the ACA or a federal derogation. ACA provided hundreds of billions of federal dollars to help states cover all those who represent 138% of the level of federal poverty – $ 21,597 for an individual in 2025.

Forty states and Washington, DC, have expanded. Georgia and Wisconsin have partially widened their eligibility for Medicaid by obtaining a federal derogation, adding them to the list of states subject to the work requirement. These two states were not included in the KFF analysis due to a lack of registration data at the county level.

Jennifer Wagner, director of MEDICAIDI’s eligibility and inscriptions at the center of the left on the budget and political priorities, said that it was delighted that the law made exceptions for places where jobs are rare. This could limit the number of people losing the coverage due to the work requirement, she said.

Wagner said that Snap unemployment exemption has helped millions of people to avoid losing their food aid, but its impact also depends on the issue of derogation.

She fears that the Trump administration will make the counties difficult to be exempt under the law of Medicaid.

“I am happy that it is there because it will certainly help people, but it is always a terrible bill,” she said. “This will not really dirty the damage to the bill.”

Kff Health News is a national editorial room that produces in -depth journalism on health problems and is one of the main operating programs in Kff – The independent source of research on health policies, survey and journalism.