The American Medical Association (AMA) adopted a policy Tuesday urging lawmakers to protect patients with complex conditions and reduce administrative burdens for impending Medicaid work requirements.
The AMA’s House of Delegates instructed the organization to work with the Centers for Medicare & Medicaid Services (CMS) and state agencies to establish “clinically grounded” exemptions from the rules that protect patients with serious medical needs (PDF).
The organization will urge states and the federal government to define “medical frailty” and “complex medical conditions” to include complex chronic or life-threatening conditions, or those that result in functional impairments or require ongoing care.
“The AMA believes that patients with serious illnesses and complex medical conditions should not face unnecessary barriers to maintaining health coverage. Neither should their caregivers,” said Melissa J. Garretson, M.D., AMA Board of Trustees member, in a statement. “Medical frailty exemptions must reflect clinical realities and protect vulnerable patients while avoiding burdensome administrative requirements that can interfere with care.”
The organization will also advocate for automatic exemptions for patients with complex medical conditions and their caregivers, according to the release.
The work requirements are set to go into effect Jan. 1 under HR-1, or the One Big Beautiful Bill Act, but states have the option to enact them sooner. The rule, finalized June 1, says able-bodied and non-pregnant adults aged 19 to 64 will be subject to requirements. Exemptions will be in place for the medically frail, disabled and others who are unable to meet the mandates.
Individuals can meet the requirement by working, completing community service or participating in a work program for at least 80 hours per month. CMS says those enrolled in educational programs for at least half-time each month also meet the requirements.
The final rule has drawn criticism from industry groups, including the Alliance of Community Health Plans and America’s Essential Hospitals.
AHCP said in a statement that the rule adds documentation requirements and stricter criteria for exemptions. It also noted that most individuals enrolled in Medicaid are already working or in school.