The Trump administration on Monday issued a final rule requiring most Medicaid beneficiaries between ages 19 and 64 to demonstrate work activity, complete community service, or participate in work programs to maintain their benefits.

The rule, stemming from the One Big Beautiful Bill Act, establishes standards that states must implement when adopting Medicaid work requirements. It represents a significant policy shift for the federal healthcare program that serves low-income Americans.

Several groups will be exempt from the work requirements, according to the administration's guidelines. Pregnant women, parents of young children, and veterans with disabilities are among those who will not be subject to the new work mandates.

The rule outlines broad policies that each state is required to have in place when implementing the work requirements. States will need to establish systems to verify compliance and track beneficiaries' work activities or exemption status.

The policy change affects millions of Americans who rely on Medicaid for healthcare coverage. Implementation details and enforcement mechanisms will vary by state as local governments adapt their programs to meet the new federal requirements.