Statement From Jesse Roach, MD, SVP of Government Relations National Kidney Foundation On Medicaid Work Requirements Interim Final Rule
(Washington DC – June 3, 2026) - "Medicaid is a lifeline for people living with kidney disease, including individuals with kidney failure who depend on dialysis, transplant care, prescription drugs, transportation, and regular access to clinicians to stay alive. Nearly half of all dialysis patients rely on Medicaid as their primary or supplemental coverage — for many, there is no backup.
The National Kidney Foundation is deeply concerned that the interim final rule does not provide strong enough protections to ensure that kidney patients with serious and complex health needs are not wrongly denied or disenrolled from coverage.
While CMS recognizes end-stage renal disease as a condition that may qualify as serious or complex, the rule does not clearly protect people with kidney failure from burdensome and inconsistent state documentation processes. That ambiguity will cost lives. Dialysis is not optional. It is life-sustaining treatment that often requires significant time, travel, recovery, and care coordination each week. A patient on in-center hemodialysis attends treatment three times per week — roughly 150 hours a year — and faces fatigue, cardiovascular complications, and comorbidities that limit their capacity on treatment days. The 80-hour monthly community engagement threshold is not a realistic standard for this population. No kidney patient should lose Medicaid because a state system failed to identify their condition, claims data were delayed, or they could not navigate a paperwork process while managing a serious illness.
The rule’s reliance on state discretion to define and verify medical frailty will produce an unacceptable patchwork of protection. A dialysis patient in one state will be automatically exempted; the same patient in a neighboring state may face months of documentation hurdles — and lose coverage in the process. CMS has the authority to close that gap, and it must use it. We are also concerned about patients in the 90-day window before Medicare coverage activates for new hemodialysis patients, and kidney transplant recipients whose immunosuppressive medications depend on uninterrupted Medicaid. Coverage loss in either group can be irreversible.
NKF urges CMS to strengthen the final policy by directing states to classify patients living with end-stage renal disease as medically frail, use existing claims data to auto-exempt kidney patients without requiring a separate patient application, accept provider documentation when data are incomplete, and minimize unnecessary paperwork for patients and providers. CMS should also establish a federal floor for the medical frailty definition that cannot be narrowed by states, and should explicitly protect kidney patients from coverage termination during any verification or pending-determination period. As states prepare for implementation, NKF stands ready to work with federal and state policymakers to ensure that Medicaid eligibility policies protect access to kidney care and do not create avoidable coverage losses for people living with kidney disease."
About Kidney Disease:
In the United States, CKD remains an under-recognized public health burden that impacts 1 in 7 adults, and 90 percent of those affected are unaware of their condition. Approximately 1 in 3 U.S. adults are at risk for CKD, but less than 20% are assessed with guideline-recommended testing, eGFR and uACR. Risk factors for kidney disease include diabetes, high blood pressure, heart disease, obesity, and family history. People of Black or African American, Hispanic or Latino, American Indian or Alaska Native, Asian American, or Native Hawaiian or Other Pacific Islander descent are at increased risk for developing the disease. Black or African American people are about four times as likely as White people to develop kidney failure. Hispanic and Native American people experience kidney failure at approximately double the rate of White people.
About the National Kidney Foundation:
The National Kidney Foundation is revolutionizing the fight to save lives by eliminating preventable kidney disease, accelerating innovation for the dignity of the patient experience, and dismantling structural inequities in kidney care, dialysis, and transplantation. For more information about NKF, visit www.kidney.org.
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For Media Inquiries:
Paul McGee (716) 523-6874 or paul.mcgee@kidney.org