Medicaid community engagement requirement

CMS Defines “Medical Frailty” for Medicaid Eligibility Purposes

With the federal government about to implement a work/community engagement requirement for eligibility for Medicaid coverage, regulators have attempted to define what constitutes “medical frailty” as a reason for exemption from that requirement. In a new report, KFF explains that a newly adopted rule presenting the Medicaid work/community engagement requirement employs “… a restrictive definition of medical frailty that differs from states’ early expectations” and ties “… medical frailty specifically to the ability to comply with the community engagement requirement (i.e., the ability to work) and prohibiting states from adding categories of individuals to the medical frailty definition.” KFF also [...]

joe2026-06-04T17:20:17-04:00June 8, 2026|Medicaid|

CMS Proposes New Medicaid Eligibility Requirements

The Centers for Medicare & Medicaid Services has published an interim final rule implementing the Medicaid work/community engagement requirements mandated by H.R. 1, last year’s federal budget reconciliation bill. The rule defines community engagement requirements for adults to gain or maintain Medicaid eligibility for applications on or after January 1, 2027. Under the rule, individuals will be eligible for Medicaid if they participate in 80 hours of employment, community service, work programs, or other qualifying activities. Under this interim final rule, states must: identify who is subject to or exempt from the work requirements verify compliance at application and renewal [...]

joe2026-06-03T08:06:29-04:00June 3, 2026|Medicaid|

States Continue to Work on Medicaid Eligibility Changes

With last year’s budget reconciliation bill – also known as H.R. 1 and the “Big Beautiful Bill Act” – requiring most Medicaid beneficiaries to have jobs or participate in community engagement activities beginning next year, the states continue to develop and refine the policies and practices they will need to implement and enforce the new requirements. The KFF has surveyed state Medicaid officials to identify what the states are doing and how they are doing it. Among Kaiser’s findings: Three states intend to implement the new Medicaid work requirements this year – ahead of the January 2027 implementation deadline – [...]

joe2026-05-05T15:41:31-04:00May 6, 2026|Medicaid|

Federal Health Policy Update for January 29

The following is the latest health policy news from the federal government for January 23-29. Some of the language used below is taken directly from government documents. Congress The Senate today failed to advance a package of the remaining six FY 2026 appropriations bills, including funding for the Department of Health and Human Services. Democratic senators continue negotiating with the White House on how to proceed with Department of Homeland Security (DHS) funding, including the possibility of separating the DHS bill from the broader appropriations package and making targeted amendments to that measure. The Labor, HHS, Education, and Related Agencies bill, [...]

joe2026-02-02T08:58:43-05:00January 29, 2026|Affordable Care Act, Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, CMMI, Congress, hospitals, MACPAC, Medicaid, Medicaid managed care, Medicaid regulations, Medicare, Medicare reimbursement policy, MedPAC, Telehealth|

Medicaid Work Rule May Hit Chronically Ill

The introduction of a work requirement for Medicaid eligibility may have the greatest impact on Medicaid beneficiaries with chronic illnesses. According to a new analysis of the approximately five million people who are likely to lose their Medicaid eligibility between now and 2034 because of the new work requirement introduced in the FY 2026 budget reconciliation bill (the “One Big Beautiful Act Bill,”) more than 85 percent have at least one chronic medical condition and more than 40 percent have at least three such conditions. The percentages rise, moreover, among current Medicaid beneficiaries over the age of 50. Some of [...]

joe2025-10-07T13:44:24-04:00October 8, 2025|Medicaid|