Republicans insist that Medicaid work requirements will only weed out people who shouldn't be on safety net program's rolls in the first place.

• The reality is that the red tape and bureaucratic hoops to jump through will have far broader effects, health policy experts say.

Why it matters: Coverage losses will be central to the reconciliation debate in the coming weeks as the Senate takes up the House-passed package containing the most significant changes to Medicaid in the program's history.

What's inside: The reconciliation bill includes a new federal requirement for those ages 19 to 64 to work or participate in 80 hours of community engagement per month to keep their Medicaid coverage.

• The requirement was supposed to kick in starting in 2029, but the House Freedom Caucus insisted the timeline be moved up to Dec. 31, 2026 — which would generate around $50 billion more in savings per year.
• The Senate still could make its own changes, though there's general support for the idea in GOP circles.

The White House contends that 4.8 million able-bodied adults are choosing not to work and said Monday that work requirements "will strengthen the system to better help those most in need of assistance."

State of play: Most able-bodied Medicaid recipients work full or part time. Some states have already imposed work requirements, resulting in thousands of people either losing their health insurance coverage or finding it difficult to sign up.

• Arkansas implemented a work requirement in 2018 that lasted less than a year and left 18,000 fewer people covered, or about 25% of the eligible population, per KFF. A court eventually ruled the program violated Medicaid law.
• Work requirements began in Georgia as part of a Medicaid expansion in June 2023, and as of January, only 6,500 adults had enrolled. The state expected 25,000 would sign up in the first year, KFF says.

The Urban Institute has estimated that up to 6 million people, or 40% of those eligible, could lose their Medicaid coverage in 2026, assuming work rules were in effect that year for expansion enrollees ages 19 to 64.

How it works: States would have to build systems to track all of the enrollees and their work status.

• Enrollees would have to make contact as often as once a month, to show that they're working or participating in another eligible activity like caretaking.
• Enrollees would have to submit paperwork to qualify for an exemption.

One concern is that the envisioned system doesn't account for informal arrangements, such as if a person is paid in cash for domestic work, seasonal jobs in agriculture or even being self-employed.

What they're saying: "The experience in Arkansas was that the people who lost coverage because of the work requirements for the most part became uninsured," said Jennifer Tolbert, deputy director of the Medicaid program at KFF.

• "In all of these states, we see time and again that the people hurt include workers who are supposed to be exempt, including people with disabilities who are supposed to be exempt," said Leonardo Cuello, a research professor at the Georgetown University Center for Children and Families.

The bottom line: Work requirements don't appear to encourage people to work, and the large savings in the reconciliation bill are likely to happen because of people losing coverage.

• "These are savings from kicking eligible people out of Medicaid who should have that coverage, who need it for their health care, because they can't navigate this big bureaucratic mess that the bill creates," said Ben Sommers, a health economist at Harvard who studies work requirements.

Read the rest

The latest Trump administration budget proposal provides new details on efforts to slash funding for the National Institutes of Health and consolidate its divisions.

Why it matters: NIH has long had bipartisan support in Congress, though the agency's role in the pandemic response and its connections to so-called gain of function research have fueled GOP calls for change.

What's inside: The budget document released late Friday provides more detail on a topline proposal to cut NIH funding by about $18 billion, or roughly 40%.

• The 27 institutes and centers would be consolidated into just eight.
• Only the National Cancer Institute, National Institute on Aging and National Institute of Allergy and Infectious Diseases would remain in their current form.
• House Energy and Commerce Committee Republicans last year called for consolidating the 27 institutes and centers into 15.

What they're saying: Congressional Democrats quickly slammed the proposal.

• "America's research enterprise has long been the envy of the world.… But President Trump is now proposing to destroy it by nearly halving the NIH's budget and gutting all kinds of cutting-edge scientific research," said Sen. Patty Murray, the top Democrat on the Senate Appropriations Committee.

The other side: "This restructuring will create efficiencies within NIH that will allow the agency to focus on true science, and coordinate research to make the best use of federal funds," the administration budget document states.

• There was no public response from leading congressional Republicans to the latest proposal.

Between the lines: The budget also calls for a focus on understanding "the root causes of autism," a priority of HHS Secretary Robert F. Kennedy Jr.

• It calls for continuing a policy to cap "indirect costs" at 15%, a controversial move that opponents have called another de facto cut to NIH grants to universities and other recipients.
• The proposal has drawn criticism from Senate Appropriations Chair Susan Collins.

1. The Kennedy effect: The HHS secretary's abrupt policy pronouncements based on limited or sketchy evidence are increasingly perplexing health care providers, industries and patients, Maya Goldman reports.
2. HHS watchdog: The department inspector general found more than $16 billion in overpayments, fraudulent billings and possible cost savings over a half year spanning the Biden and Trump administrations, Maya reports.
3. Moderna COVID vax: The FDA approved Moderna's next-generation COVID-19 vaccine for adults 65 and older and those 12 to 64 years old who are at risk of severe infection.
4. Garbled report: The MAHA commission report garbled scientific references and invented studies through the apparent use of AI, WaPo reported.

1. Prior authorization: GAO recommended that Medicare administrators focus on behavioral health services in reviews of how Medicare Advantage plans use prior authorizations.
2. Trans care: CMS wrote select hospitals seeking billing codes and projected revenue from treating gender dysphoria in children, along with how they plan to change clinical practice guidelines to fit with a recent department review.
3. Vaccine schedule: CDC posted an updated schedule saying that children over 6 months old can get COVID-19 shots after a consultation with a medical provider.