Today Virginia governor Ralph Northam signed into law a state budget that extends health care coverage to an estimated 400,000 low-income Virginians through the Medicaid program. Virginia is now the 33 rd state, in addition to Washington, D.C., to accept federal funding to provide health insurance coverage to adults earning less than 138 percent of the federal poverty level—just under $17,000 a year for a single adult. As part of the expansion, Virginia will require Medicaid recipients attend school, work, partake in job training or engage in some kind of community engagement for upwards of 80 hours a month in order to receive benefits. This requirement could pose significant challenges to cancer patients and survivors.