\n<\/p>\n
Alice Thornton has spent more than two decades treating people living with HIV in Lexington, Kentucky.<\/p>\n
Her team tends to \u201ccringe\u201d anytime they hear about patients having to fill out lots of paperwork, like when applying for Social Security Disability payments, because it can be a difficult, burdensome process.<\/p>\n
Thornton tries to support her patients, she said, but understands the limits of her training.<\/p>\n
\u201cA lot of times the forms are so complex that I don\u2019t really know what\u2019s the true definition of what this form is asking me,\u201d she said. \u201cWe refer them to a disability provider.\u201d<\/p>\n
Doctors including Thornton worry they\u2019ll see more of those kinds of requests because of coming changes to Medicaid, the government health insurance program for people with low incomes or disabilities. Starting Jan. 1 in most of the country, some enrollees \u2014 mainly adults without dependents \u2014 must prove they\u2019re working or performing other qualifying activities 80 hours a month.<\/p>\n
Final regulations<\/a> issued in June say people can obtain an exemption if they\u2019re \u201cmedically frail,\u201d or too sick or disabled to work, which may require them to submit documentation from a medical professional. That standard prompted a lawsuit at the end of June from dozens of mostly Democratic-led states and has Thornton worried it could force her and her staff to assess things like how much a patient can lift or how far they can walk.<\/p>\n \u201cIf I\u2019m asked, \u2018Is this person medically frail?\u2019 What does that even mean?\u201d Thornton said. \u201cI don\u2019t know, and I\u2019ve been doing this for 25 years.\u201d<\/p>\n Last year\u2019s GOP tax-and-spending law known as the One Big Beautiful Bill Act established the work rule, which will affect an estimated 18.5 million Americans<\/a> when more states start enforcing it. The mandate is expected to cause a larger increase in the number of people without health insurance than any other part of the law, notes KFF,<\/a> a health information nonprofit that includes KFF Health News.<\/p>\n Doctors say they aren\u2019t trained to accurately assess whether someone\u2019s health keeps them from working. Many don\u2019t have time to handle another administrative task that takes them away from patient care. And being involved in whether someone gains access to a public benefit undermines the doctor-patient relationship, several doctor groups and physicians said.<\/p>\n \u201cWhen you introduce unnecessary, non-evidence-based, confusing, and bureaucratic policies like this into clinical care, it just raises the level of moral distress for providers,\u201d said Christopher Chen, a senior healthcare adviser at the consulting firm Manatt.<\/p>\n The Centers for Medicare & Medicaid Services declined to respond on the record about doctors\u2019 concerns. But the agency confirmed that enrollees may need to get documentation from a clinician to prove they\u2019re too sick to work and said states would make final determinations.<\/p>\n The Trump administration has previously said states should use available data sources \u2014 such as medical claims and payment data \u2014 before making patients submit proof of medical frailty from a provider.<\/p>\n \u201cDocumentation should be relatively easy to provide,\u201d Mehmet Oz, the CMS administrator, said during a June 1 press call.<\/p>\n But deciding whether a patient is too sick to work is a subjective, high-stakes decision, said Chen, who also practices as a hospitalist at Valley Medical Center in Renton, Washington.<\/p>\n \u201cWe\u2019re trained to take care of people,\u201d he said. \u201cWe\u2019re trained to learn about someone\u2019s symptoms, make diagnoses, treat them. We\u2019re not trained to make these kinds of work determinations.\u201d<\/p>\n When they apply and every six months after, Medicaid enrollees subject to the rule will have to prove that they\u2019re performing the minimum monthly hours of qualifying activities \u2014 or will likely have to prove as frequently that they qualify for an exemption.<\/p>\n If states can\u2019t find sufficient evidence that someone is too sick to work, that person will be able to self-attest to it under penalty of perjury \u2014 but only for a short time. States may take someone\u2019s word that they\u2019re medically frail twice in 2027 and only once in 2028.<\/p>\n Last month, 25 mostly Democratic-led states sued the Trump administration<\/a> over the final regulations, arguing the medical frailty standard would be too hard for enrollees to meet \u2014 and for states to assess.<\/p>\n The standard, they argue, requires state Medicaid agencies to \u201ctake on the role of occupational medicine experts\u201d or adds that burden to physicians who are not necessarily trained in occupational medicine.<\/p>\n CMS declined to comment on the litigation.<\/p>\n The Trump administration has crusaded against fraud in government health programs including Medicaid. It recently charged hundreds of defendants<\/a> \u2014 including medical professionals \u2014 over more than $6.5 billion in alleged fraud schemes.<\/p>\n CMS has said it will keep a close watch on how states administer the work requirements and may take corrective action if states step out of line.<\/p>\n That has doctors concerned about the potential repercussions if they incorrectly assess whether someone is too sick to work, as farfetched as those worries might be, said Rahul Vanjani, a primary care and addiction medicine physician and researcher at Brown University.<\/p>\n \u201cWe, using our imaginations, wonder if someone is auditing these forms in the background and if they\u2019re going to reach out to the licensing board.\u201d<\/p>\n The country is short thousands<\/a> of primary care providers, and it could be hard for people seeking an exemption to find a clinician to help them document that they\u2019re too sick to work, doctors said.<\/p>\n It will be even more challenging for someone without insurance, said Jennifer Wagner, who researches Medicaid eligibility at the left-leaning Center on Budget and Policy Priorities.<\/p>\n \u201cHow could an applicant who doesn\u2019t have health coverage get a doctor\u2019s note?\u201d she asked.<\/p>\n The American Medical Association, the nation\u2019s largest professional association of doctors and medical students, lobbied federal officials to change the standard for documenting medical frailty in the days before the final regulations were made public.<\/p>\n