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. Peer-reviewed data published in August 2026 says the same thing about the national rule: two-thirds of the people it targets already work — and one in five is still at risk of losing coverage. We generate the physician-signed medical frailty attestation. You keep your coverage.
Up to 10.1 million people could lose Medicaid by 2028.
Most of them qualify for an exemption. The problem is documentation, not eligibility. In Arkansas's 2018 pilot, 95% of people who lost coverage were exempt or working — they failed the paperwork, not the requirement. The same failure is about to happen 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, or not ready to pay: build your baseline record free. 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.
Identify patients who need structured home support before they leave your facility.
medfrail.com generates a physician-signed frailty attestation that travels with the patient. It documents the care gap so your team, the patient's family, and any home care service all start from the same baseline. Fewer calls back. Fewer readmissions.
Partner with us on discharge documentationKnow what to watch for in the first week home.
The 72 hours after hospital discharge are the highest-risk window. A frailty attestation is the first step — it documents your family member's condition and flags which daily activities are at risk. Use it to structure care, qualify for HSA/FSA coverage, and brief any home caregiver on exactly what matters.
Start their baseline record, freeThree steps. One physician. Pay only if they sign.
Every attestation is reviewed and signed by a licensed physician matched to your condition.
Upload records
Start with your email. We confirm your intake, tell you which records to gather (diagnoses, medications, prior physician letters, recent discharge summaries), and tell you your turnaround. Records go to the reviewing physician by a method they control — this page collects nothing but your email.
Physician review
A physician licensed in your state reviews your file against the federal “significantly impairs” standard and either drafts an attestation or tells you exactly what the record is missing. We currently serve Colorado, California, Virginia, and Louisiana; if you are elsewhere, we say so at intake rather than take your money.
Keep your coverage
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 pay nothing and you get the reason in writing.
Tap every category that applies to you. See your likely exemption status.
Federal law names eight categories. You only need one. This is not a medical or legal determination — it is an orientation. A physician makes the actual assessment when you start.
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 writing your attestation.
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.
medfrail.com matches you to a licensed physician who makes that assessment for your attestation.
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. We match you to a physician licensed in your state (currently CO, CA, VA, LA); if your record supports it, you get a signed attestation. If not, you pay nothing.
My members are at risk.
Every enrollee who churns off costs you capitation revenue. medfrail.com is built to clear frail members through exemption at scale — protecting your book without your staff doing the work.
My patients need documentation.
Your safety-net patients maintain coverage and you maintain reimbursement. We plug into your EHR, generate attestations for your frail panel, your revenue cycle stays intact.
Built for defensibility. Made to scale.
What our physician of record signs — and what they won't.
Our physician of record handles medfrail attestations. A physician drafts “if appropriate” — and that phrase is doing real work. Here is what it means.
- ✓ Attestations the record supports. A licensed physician reviews your file and — if appropriate — drafts an attestation against the federal OBBBA medical frailty criteria.
- ✓ 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.
- ✓ Audit-ready documents. A signed, timestamped PDF with citation to the specific OBBBA criteria you meet.
- ✓ Only what a physician has reviewed. Every attestation is reviewed and signed by a licensed physician — none is submitted 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. We generate medical documentation reviewed and signed by licensed physicians.
Start your attestation. Keep your coverage.
One flat price, charged only if a physician signs. Declines are free.
- Physician-signed medical frailty attestation — a signed, timestamped PDF, ready to submit to your state Medicaid agency.
- Cited to the exact federal criteria you meet — references the specific OBBBA medical-frailty categories (H.R.1, P.L. 119-21), built to hold up in an audit.
- Reviewed by a physician licensed in your state — currently CO, CA, VA, LA. No physician signature, no attestation, no charge.
- 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.
- Turnaround stated at intake — we tell you the review window when we confirm your intake, not before we know who is reviewing.
Enter your email. We send your secure intake within one business day — then a licensed physician takes it from there.
An attestation is medical evidence, not a verdict — final eligibility determinations are made by your state Medicaid agency. If the record doesn't support an attestation, our physicians won't sign one. See what they sign — and what they won't.