Opinion: Lawmakers promised cancer patients would be protected from Medicaid cuts. Now CMS says otherwise

OpinionFirst Opinion Lawmakers promised cancer patients would be protected from Medicaid cuts. Now CMS says otherwise New work requirements are catastrophic Manage alerts for this article Email this article Share this article By Gwen NicholsJune 4, 2026 Nichols is a hematologist/oncologist, cancer researcher, and chief medical officer of Blood Cancer United. In May 2025, I joined more than 160 blood cancer advocates on Capitol Hill. At the time, Congress was considering changes to Medicaid, a state and federal program that is a lifeline for more than 75 million Americans, including older adults, children, veterans, people with disabilities, pregnant people, and adults with low incomes. Together, we advocated against policies that threatened to put health care out of reach for millions. One of those concerning policies was work reporting requirements for people covered by Medicaid. The then-proposed legislation mandated that states verify Medicaid enrollees’ monthly work status at least every six months to ensure that they are engaging each month in a minimum of 80 hours of community service, educational activities, and/or work. But undergoing cancer treatment is already a full-time job; many patients are unable to work because of their condition. Advertisement Our meetings with congressional staff and lawmakers were tense. Many lawmakers were surprised to hear our concerns, given that the legislation they were considering included an exemption for people with serious conditions like cancer. When we shared that exemptions previously failed to protect patients, many lawmakers told us we were misinformed or being lied to. Lawmakers were clear that the legislation’s protections were rock solid: No one with cancer would lose their coverage. A few weeks later, the One Big Beautiful Bill Act (OBBBA) — and Medicaid work reporting requirements — became law. On Monday, the Centers for Medicare and Medicaid Services issued its interim final rule on work reporting requirements. It breaks lawmakers’ promises to patients. The rule is catastrophic for cancer patients and forces states to go far beyond what Congress included in its legislative text. It narrows the “medical frailty exemption,” a mechanism that allows patients with cancer and other serious health conditions to be exempt from work reporting requirements. In effect, it means that cancer patients, including those in active treatment, could be forced to work the same number of hours as a healthy person — regardless of whether that’s physically possible, just to keep the health insurance coverage that they rely on to stay alive. Advertisement In other words, one of the cancer community’s worst fears — which we were assured repeatedly would never happen — is coming to pass. The rule also limits patients’ ability to attest that they qualify for their exemption. I don’t know a single cancer patient who would choose not to work if they could. But rather than trusting patients to certify that they have a health condition that precludes them from work reporting requirements, starting nationwide in 2028, patients now face red tape. We don’t know exactly how states will require patients to “prove” their inability to work 20 hours a week, but it seems likely that some patients will need to work with their doctors to submit a written assessment of their ability to work to Medicaid to prevent loss of their insurance. As a result, patients will be inundated with paperwork. One small misstep by a patient, provider, contractor, or state employee could mean the difference between having health coverage and losing it. Research shows that continuous access to Medicaid is critical to the survival of children and young adults with cancer. The interim final rule is in direct conflict with OBBBA. While Congress chose to implement these work reporting requirements, it also carefully chose to exempt people with serious medical needs, like cancer patients, from them. In fact, just weeks before the final bill passed, Brett Guthrie, chair of the House Energy and Commerce Committee, wrote in the New York Post: “This policy applies only to able-bodied, unemployed adults who have chosen not to work. Our bill couldn’t be clearer about that; it includes a long list of exempted individuals. For instance … you’re exempt if you’re medically frail, which includes anyone who’s blind, disabled, battling a chronic substance-use disorder or living with a serious and complex medical condition like cancer.” But that’s not what the new interim rule does. Instead of ensuring those who need care the most can get it as Congress prescribed, it erects barriers, jeopardizing patients’ ability to focus on what matters most: their health. Advertisement Since the rule doesn’t take effect until July 31, 2026, there’s still time for the administration to correct it — and for Congress to ensure that their promises of exemptions were not hollow. I urge them to take that opportunity. Why? Because the final interim rule just does not work. If left in place, it will cause irrevocable harm — not just for cancer patients, but for anyone living with or caring for someone with a serious or chronic condition. And for some, it will be deadly. We know this because we’ve already seen it. Both Arkansas and Georgia implemented Medicaid work requirements during the first Trump administration, and they serve as cautionary tales. In Arkansas, implementation of work requirements led to significant coverage losses and no increase in employment. Georgia saw small coverage gains — but at a prohibitively expensive operating cost. Even before the new rule, patients have struggled to get the care they are entitled to. Brian Becker, a 32-year-old father and leukemia patient from Texas, died while he was waiting to qualify for Medicaid coverage. While his family was mourning his death, they received a denial letter stating he didn’t qualify for disability. His tragedy isn’t unique, and if CMS doesn’t change course, stories like these will be even more common. That’s not the reality I want for patients, who are already undergoing significant physical, emotional, and financial challenges. For instance, take Amanda Brunson, a Florida-based volunteer with Blood Cancer United. Amanda was diagnosed with acute lymphoblastic leukemia at 21 years old and again at 25. She credits Medicaid for saving her life; without it, she would not have been able to afford treatment, medications, food, or stable housing. Amanda’s journey was grueling. She recalls being severely fatigued, passing out trying to bathe herself, and losing so much weight that she was a mere 88 pounds. Working or navigating mountains of paperwork on top of her illness would have been impossible. Advertisement Her experience isn’t uncommon. Blood cancer treatments are effective, but they are far from easy to endure. And many patients, like Amanda, don’t have a smooth return to “normal life.” They remain immunocompromised; contracting a simple cold could put them back in the hospital, or worse. They must take precautions to minimize their risk — precautions that can prevent them from sustaining regular employment. Ushering cancer patients into an era of extra uncertainty and chaos when their lives are already on the line is wrong. But there’s still time to make it right. Gwen Nichols is a hematologist/oncologist, cancer researcher, and chief medical officer of Blood Cancer United, formerly The Leukemia & Lymphoma Society. Letter to the editor Have an opinion on this essay? 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