The federal government on Friday announced a six-month delay in enforcing a Medicaid work requirement — a central provision in President Donald Trump’s “big, beautiful bill” that experts said would lead millions of Americans to lose health coverage.

The requirement still technically starts on Jan. 1, but under new guidance from the Centers for Medicare & Medicaid Services, states that choose not to enforce it won’t be held accountable until at least July 1.

The move is a striking turn for an administration that has spent months defending the policy against criticism from state officials and healthcare advocates who warned that the rollout was moving too quickly and that people who should be eligible for Medicaid would lose coverage because of the additional red tape and paperwork.

CMS called the six-month window a “hold harmless” period, and the delay is optional. States that choose to take advantage of this period will still start checking on Jan. 1 whether Medicaid enrollees are working, volunteering or in school or whether they qualify for an exemption. But until July, no one in those states will lose coverage for failing to meet the requirements.

“States have made real progress, and they’ve been clear with us about what it takes to get this right for beneficiaries — at scale and for the long term,” said Dan Brillman, who oversees Medicaid at CMS.

The White House declined to comment.

Some states have already moved forward with implementing the work requirements. In Nebraska, which launched the work requirements May 1, over 1,000 people have lost coverage or been denied benefits because of the new rules, according to state figures through August.

The Medicaid work requirement was a cornerstone of Trump’s “big, beautiful bill,” a massive tax and spending package that overwhelmingly benefited the wealthy through tax breaks while slashing the social safety net for vulnerable Americans. Millions of Americans are expected to lose health coverage and food assistance as a result of the law, the signature domestic legislation of Trump’s second term.

The law requires many able-bodied adults under the age of 65 to prove they work, volunteer or attend school at least 80 hours a month to keep Medicaid, which provides health coverage for low-income and disabled Americans. The Trump administration argues the requirement and other provisions in the law encourage work, reduce waste and protect government benefit programs for those who need them.

The Congressional Budget Office estimated the work requirements alone would leave 5.3 million more people uninsured by 2034 and would save the federal government $317 billion, part of nearly $1 trillion in Medicaid cuts in the law.

Pressure on the administration to delay the requirement had been building for months. Five Democratic governors last month asked Health Secretary Robert F. Kennedy Jr. to postpone the implementation, saying that state agencies weren’t ready. And a federal judge last month blocked the Trump administration from enforcing a portion of the requirement related to medically frail people, saying it could lead some to wrongly lose coverage.

The delay comes a little more than a week after Democrats won control of both chambers of Congress on a promise to reverse the GOP’s cuts to healthcare and food assistance.

“Millions of people’s health care is at risk because of the Republican reconciliation law’s work requirement, as states scramble to implement on a rushed timeline & respond to shifting federal requirements,” Sarah Lueck, vice president for health policy at the Center on Budget and Policy Priorities, said in a post on X. “Today’s news lets states delay the harm.”