On June 1, the Centers for Medicare and Medicaid Services issued an interim final rule on Medicaid work requirements that adopts a restrictive definition of medical frailty — differing from states’ early expectations. KFF’s Jennifer Tolbert explains why the more restrictive definition of medical frailty adopted by the Trump Administration will be challenging for states to implement and could lead to more people falling through the cracks and losing coverage.

This brief features maps showing how insurer participation has changed at the state and county level from 2025 to 2026 as well as insight into the number of issuers offering plans at specific metal levels.