The federal government announced on Friday a six-month delay in enforcing a Medicaid work requirement, a central provision of President Donald Trump's "big, beautiful bill" that experts said would lead millions of Americans to lose health coverage. The requirement still technically starts on Jan. 1, but under new guidance from the Centers for Medicare & Medicaid Services, states that choose not to enforce it will not be held accountable until at least July 1.

The move marks a striking turn for an administration that had spent months defending the policy against criticism from state officials and healthcare advocates, who warned that the rollout was moving too quickly and that people who should be eligible for Medicaid would lose coverage because of added red tape and paperwork. CMS called the six-month window a "hold harmless" period, and the delay is optional. States that take advantage of it will still begin checking on Jan. 1 whether enrollees are working, volunteering or in school, or whether they qualify for an exemption, but no one in those states will lose coverage for failing to meet the requirements until July. Dan Brillman, who oversees Medicaid at CMS, said, "States have made real progress, and they've been clear with us about what it takes to get this right for beneficiaries, at scale and for the long term." The White House declined to comment.S2S1

Some states have already moved ahead. In Nebraska, which launched the work requirements on May 1, more than 1,000 people had lost coverage or been denied benefits because of the new rules, according to state figures through August. The requirement was a cornerstone of the broader tax and spending package that Trump signed into law, which overwhelmingly benefited the wealthy through tax breaks while cutting the social safety net. The law requires many able-bodied adults under 65 to prove they work, volunteer or attend school at least 80 hours a month to keep Medicaid, which provides health coverage for low-income and disabled Americans. The administration argues the requirement encourages work, reduces waste and protects benefit programs for those who need them.S2

The Congressional Budget Office estimated that the work requirements alone would leave 5.3 million more people uninsured by 2034 and save the federal government $317 billion, part of nearly $1 trillion in Medicaid cuts in the law. Pressure to delay the requirement had been building for months. Five Democratic governors last month asked Health Secretary Robert F. Kennedy Jr. to postpone implementation, saying that state agencies were not ready to carry out the checks.S2