Medicaid requirements are changing

(CNN)– Millions of sick Americans could have a tougher time retaining medicaid coverage after the first-ever federal work requirement begins in January in most states.

The centers for medicare and medicaid services issued a new rule this week that takes a harder line on defining which enrollees are eligible for an exemption due to medical frailty.

The rule guides states on implementing the work mandate.

It says to qualify for the exemption enrollees must not only have an illness or medical condition, but that condition significantly impairs their ability to comply with the work mandate.