Most people who lost Medicaid under work requirements actually qualified.
In Arkansas's 2018 pilot — the only state to implement work requirements before courts struck them down — 95% of people who lost coverage were working, exempt, or both. They failed the paperwork, not the requirement.
What works today: a dated record of your condition that stays on your device, so you have something specific to show your state, and a practice run of the call to your Medicaid office. Physician review is planned and not open yet.
Of every 100 people who lost coverage, 95 were working, exempt, or both.
medfrail in 15 seconds
- Most who lost coverage qualified. Arkansas 2018: 95% were working, exempt, or both.
- Frailty is a measured state. A 1-to-9 clinical scale, not a feeling.
- A dated record, on your device. Nothing leaves it. Print it, keep it with your papers.
- Then check with your state. Each state decides whose documentation it accepts.
- medfrail. Keep your Medicaid. medfrail.com
Up to 10.1 million people could lose Medicaid by 2028.
Many of them already meet the rule or qualify for an exemption. The trouble is proving it. In Arkansas's 2018 pilot, about 95% of people who lost coverage were working, exempt, or both: they failed the paperwork, not the requirement. The same paperwork gap is the risk at national scale.
You can work full-time and still fail this rule.
Researchers at Boston University and the University of South Carolina studied employment in all 40 Medicaid expansion states. Two-thirds of the people this rule targets are already in the labor force — and 85% of those average more than 35 hours a week, roughly double what the rule asks. One in five is still at risk. The rule does not measure whether you work. It measures whether your hours are legible to a state computer, every single month.
The study’s lead author names the gap precisely: the rule is hardest on people with less education, part-time or gig work, less control over their hours — “and those who have substantial health concerns that may not rise to the level of a documentable disability.”
That last group is the one medfrail exists for. You do not need to qualify for disability. The federal standard is narrower and more specific than that: a serious physical, mental, or behavioral health condition that significantly impairs your ability to comply. It is a functional test, not a diagnosis list — which means it has to be documented by someone qualified to assess function. That is what a physician attestation is.
See where you fall on the clinical frailty scaleMost of the 19.8% are not medically frail. They are people whose employer changed the schedule. We cannot write an attestation for that, and we will not try. A physician signs a statement about your health, or signs nothing — and an attestation that overreaches is worse than none, because it is the one a state will audit.
If your hours are unstable but your health is not the reason, the route that works is the other 80-hour path: school, job training, or structured volunteering through a nonprofit or public organization all count the same as paid work. Some health systems are now running volunteer programs specifically so their patients can meet the requirement. Ask yours. If a health condition is part of why the hours don’t add up, that is the case we take.
And if you are not sure yet: build your baseline record. It stays on your device, it is dated, and from January 2028 a dated trail is what the state will ask for.
How health systems are covering both routesAnalysis of 2023–2025 federal survey data across 40 expansion states and DC. “At risk” = within ±5 hours of the 20-hour weekly threshold, or reporting hours that vary by more than ±5 from usual.
One printed page for the client who says “my health is why I can’t work 80 hours.”
When to point a client to a dated record that stays on their own device, what it does and does not do, and why the state decides what it accepts.
Open the one-pagerHow many of your members are at risk of losing coverage on paperwork.
A model you can run in your browser, with its sources on the page. Physician review is planned, not open, and nothing is priced.
Run the estimateThree steps. Start with your record. Nothing is charged today.
When review opens, every attestation will be reviewed by a licensed physician and signed only if your record supports it. Today, build your record and practice the call.
Join the review list
Start with your email and state. When physician review opens, a person writes to you about which records to gather (diagnoses, medications, prior physician letters, recent discharge summaries) and how they reach the reviewing physician. This page collects nothing but your email and state.
Physician review
Planned, not open yet: a licensed physician would review your file against the federal “significantly impairs” standard and either draft an attestation or tell you exactly what the record is missing. Our physician of record is licensed in all 50 states and DC. The intake checks that review is open in your state and says so plainly if it isn’t. Check one thing first: your state decides which clinicians’ documentation it accepts, and many ask for the provider who treats you. If your state won’t accept our reviewer, your own doctor or clinic is the better route — and the dated record helps them.
Take it to your state
When review opens: if the physician signs, you receive a signed, dated attestation that names your condition, describes the functional impairment, and cites the specific federal criterion. Submit it to your state Medicaid agency. If the physician declines, you get the reason in writing.
Tap every category that applies to you. See what may fit.
These are the categories this check screens. You only need one. This is not a medical or legal determination. It is an orientation, and your state decides.
This self-check is educational, not a legal or medical determination. One selected category is sufficient to start the attestation process. A licensed physician makes the final determination.
Frailty is not a feeling. It's a measured clinical state.
Clinicians describe frailty on a 1-to-9 scale — from very fit to terminally ill. Move through it below to see what each level means for daily life, and what it implies for care planning. This is the same vocabulary a physician uses when documenting frailty.
Educational illustration of the Clinical Frailty Scale (Rockwood et al., Canadian Study of Health and Aging).
Plain-language summary only — not a diagnosis. A frailty level is assigned by a clinician reviewing your full history.
When physician review opens, a licensed physician would make that assessment; today the level you pick is your own placement, kept on your device.
Enrollees, health plans, and providers — same attestation engine.
I might lose my Medicaid.
You've heard about the new work requirements and you're worried. Start with the dated record on your own device, and practice the call to your Medicaid office. Physician review is planned and not open yet; nothing is charged, and a person writes to you when it opens.
My members are at risk.
Every enrollee who churns off costs you capitation revenue. medfrail.com is planning an exemption-documentation service for frail members. Nothing is open or built for plans yet.
My patients need documentation.
Your safety-net patients maintain coverage and you maintain reimbursement. A planned attestation service for your frail panel. Nothing is open or priced yet, and EHR integration is not built.
Built for defensibility. Made to scale.
What our physician of record signs — and what they won't.
When review opens, a licensed physician of record will handle medfrail attestations. A physician drafts “if appropriate” — and that phrase is doing real work. Here is what it means.
- ✓ Attestations the record supports (planned, not open yet). A licensed physician would review your file and — if appropriate — draft an attestation against the federal OBBBA medical frailty criteria. Your state decides whose documentation it accepts — check with your state first.
- ✓ Any of the eight federal categories. Disability, serious or complex medical condition, substance use disorder, disabling mental disorder, caregiving role, pregnancy or postpartum, foster youth, veteran with total disability. You only need one.
- ✓ Documents a caseworker can check (planned). When review opens: a physician-signed PDF citing the specific OBBBA criteria your record supports.
- ✓ Only what a physician has reviewed. When review opens, every attestation will be reviewed and signed by a licensed physician — none will be issued without that signature.
- ✗ Files with a documentation gap. A draft that doesn’t hold up goes back for clarification or additional records — not into the signature queue.
- ✗ Frailty where there isn’t any. On the 1–9 clinical frailty scale above, levels 1–3 — very fit, fit, managing well — are unlikely to qualify.
- ✗ Your state’s decision. Final eligibility determinations are made by your state Medicaid agency — an attestation is evidence, not a verdict.
- ✗ Legal representation. We are not legal representatives. Today we provide only the on-device record and call practice; when physician review opens, a licensed physician will review and sign or decline.
Join the review list. Build your record now.
No price and no checkout. Leave your email and state and we write when physician review opens.
- Planned: a physician-signed medical frailty attestation — a signed, dated PDF to bring to your state Medicaid agency, if your state accepts it.
- Cited to the federal criteria your record supports — references the specific OBBBA medical-frailty categories (H.R.1, P.L. 119-21).
- Planned: review by a licensed physician, not open yet. Your state is checked first. Nothing is charged today.
- Records go to the physician, not to this website — after we confirm your intake, you send diagnoses, medications, and prior letters by the method the reviewing physician specifies.
- No turnaround promised — review is not open yet, so there is no review window to quote.
Enter your email and state. Physician review is not open yet, so you join a list: we log your state and a person writes to you when review opens. Nothing is charged.
An attestation is medical evidence, not a verdict — final eligibility determinations are made by your state Medicaid agency. When review opens, a physician will decline any case the record doesn't support, and say why in writing. See what they sign — and what they won't.