Now, Kennedy will have almost total, personal authority over his department’s definition of who is “medically frail” and who has “special medical needs,” definitions that will play a central role in determining who is actually able to get exemptions from Medicaid work requirements—and how Medicaid users will be screened.

There are multiple ways disabled people could lose Medicaid coverage when work requirements hit, says David Machledt, a senior policy analyst with the nonprofit National Health Law Program. “Sometimes, it may be the definition being too narrow to capture people who have real barriers to employment,” he said. “There’s also just as likely going to be bumps from and coverage loss that comes…when the state sets up a verification regime.”