October 22, 2026

Doctors for America Opposes CMS’s Restrictive Medical Frailty Rule

WASHINGTON, D.C. – Doctors for America (DFA) is deeply concerned about the Centers for Medicare and Medicaid (CMS) final rule, released June 1, 2026, for determining medical frailty; this final rule will guide HR 1 implementation of Medicaid work requirements for enrollees in expansion states starting January 1, 2027. This law importantly allowed exemptions for pregnant persons, children, disabled people, those on Medicare, and enrollees with “medical frailty,” but the new CMS rule greatly complicates the determination of “medical frailty." DFA anticipates that the supplemental rule will have harmful impacts on both patients and providers.

DFA interprets Medicaid work requirements as a legislative and bureaucratic effort to fund less medical care for our most vulnerable patients without violating the legal requirements of existing Medicaid law. When Arkansas fully implemented Medicaid work requirements in 2018, more than 18,000 adults lost coverage, largely due to reporting barriers, confusion, and red tape rather than a lack of employment. Studies showed that roughly 95% of those who lost Medicaid coverage either already worked or should have qualified for an exemption. Administrative costs were significant. Health protection was lost and employment rates did not improve.  

Medical frailty is a complicated, nuanced and ever-changing indication of vulnerability. A patient may be clinically stable, but struggle with conditions that are chronic and unstable such as heart failure, diabetes, cancer, severe depression, autoimmune diseases, epilepsy, or long COVID that make consistent work impossible. A single snapshot in time cannot accurately reflect the underlying challenges chronically ill patients face - and the impact these challenges have on their ability to work, volunteer, or go to school.

Millions of people will lose insurance. According to the Urban Institute implementation of these new Medicaid work requirements would likely cause a loss of 5.2 million adults on Medicaid by 2034 with the goal of $324 billion in federal budget savings in the same time period. This will result in a significant rise in uninsured people who cannot afford medical care and must rely on free or charity care, putting substantial financial strain on clinics and hospitals.

Loss of insurance will lead to poor health outcomes. The proposed narrow definition of medical frailty in the expanded rule puts our most vulnerable patients at risk for discontinuous medical care and the development of catastrophic and even fatal complications. Losing Medicaid coverage will result in delayed or omitted medications, missed medical assessments, untreated mental illness, interrupted care, and unmanaged chronic diseases. Nor does this save the health care system money; uninsured chronically ill people will seek care only after becoming acutely ill, frequently accessing more expensive care in emergency departments.

Proving medical frailty will be an administrative nightmare. Starting in 2028, states will now be required to document medical frailty, a complicated procedure that depends on accuracy and completeness of records and claims data. Even when medically frail individuals qualify for exemptions, proving eligibility will require medical documentation every 6 months, repeated forms and certifications, and interactions with state agencies that many patients cannot complete successfully due to confusion, health literacy, technology literacy, language barriers, child care, transportation and time. If a patient’s condition worsens, a timely and rapid appeal process must be in place. This new rule also imposes more administrative burden on already strained healthcare systems and an undue burden on physicians and healthcare staff. 

Across the country physicians, clinics, hospitals and health systems who serve these vulnerable Medicaid populations already are in extremely short supply, due to chronically low reimbursement, difficulties in arranging specialty consults, and the challenges of managing complex disease cases. These rule changes will necessitate taking time away from care of the ill to do bureaucratic work (likely without any increased reimbursement), and will cause further burnout and strain for healthcare staff, exacerbating current challenges around retention and workforce in the healthcare system.  

Documentation requirements and frailty assessments will also interfere with the clinician-patient relationship. Clinicians may be forced to deem some, now stable, chronically ill, patients ready to work, putting them at risk of losing their Medicaid and the continuity of care which maintains their quality of life. CMS notes that states’ frailty determinations will be auditable, and if states are found to have designated an individual to be medically frail with little to no support for that conclusion, states could be subject to financial penalties. This puts healthcare clinicians in an impossible and unethical position to choose between complying with these restrictive laws, thus risking their patient losing insurance, or risking their state’s undergoing penalties for non-compliance.

In summary, DFA strongly opposes Medicaid work requirements and the restrictive definitions for medical frailty, and urges CMS to broaden these definitions to ensure the sickest, most vulnerable patients can maintain access to life-saving medical care.

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About Doctors for America:

Doctors for America (DFA) is a national nonprofit that mobilizes over 40,000 physicians and medical trainees to advocate for policies that improve the health of patients and communities. Through advocacy training and action at the state and federal levels, DFA works to expand access to affordable care, strengthen community health and prevention, and advance health justice and equity. We do not accept funding from pharmaceutical, insurance, or for-profit health care entities, ensuring our work remains fiercely independent and patient-centered. DFA puts patients over politics–and over profits. Find out more at doctorsforamerica.org and on X @drsforamerica or Bluesky drsforamerica.bsky.social.

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