Medicaid eligibility criteria

CMS Fleshes Out “Medical Frailty” Criterion for Medicaid Eligibility

When Congress included major reductions in Medicaid eligibility in last year’s budget reconciliation bill – H.R. 1, often referred to as the “One Big Beautiful Bill Act” – it included one criterion for Medicaid eligibility that immediately proved challenging. While the new law requires individuals to work or participate in “community engagement” activities such as attending school or performing volunteer work” as a condition of Medicaid eligibility, it offered an exception to this requirement: those found to be “medically frail.” The law, however, did little to define what constitutes medical frailty beyond defining as medically frail those who are blind [...]

joe2026-09-15T16:39:05-04:00September 16, 2026|Medicaid|

Some States Seek to Expand Medicaid Work Requirements

While last year’s H.R. 1, often referred to as the “One Big Beautiful Act Bill,” introduced a requirement that Medicaid applicants document that they have worked, attended school, or participated in some form of community engagement for one month as a condition of eligibility for the program, a few states are looking to make that requirement more rigorous. Indiana, for example, has turned that one-month requirement into three months and Missouri, Arizona, and Kentucky are considering increasing the requirement as well. Missouri officials are even proposing a constitutional amendment that would ban the state from expanding the scope of current [...]

joe2026-04-29T10:33:23-04:00April 30, 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|

CMS Fleshes Out Medicaid Work Requirement

The Centers for Medicare & Medicaid Services has issued additional guidance to the states on how to implement the work and community engagements established as part of the criteria for Medicaid eligibility under H.R. 1, commonly known as the One Big Beautiful Bill Act, which was signed into law in July. The requirements seek to connect able-bodied, working-age adults with work and community engagement activities and reduce inappropriate Medicaid enrollment. The states are required to implement these requirements by January 1, 2027 but may do so sooner if they wish. In providing this guidance, CMS enumerates four major principles, quoted [...]

joe2025-12-10T12:57:33-05:00December 11, 2025|Centers for Medicare & Medicaid Services, Medicaid|

Federal Health Policy Update for April 24

The following is the latest health policy news from the federal government for April 18-24. Some of the language used below is taken directly from government documents. Congress The House and Senate are in recess until April 28. Upon their return to Washington D.C., committees will begin marking up reconciliation legislation for submission to their respective chambers’ budget committees by May 9. The Energy and Commerce Committee is expected to mark up its bill, with $880 billion in cuts, the week of May 5. The committee is expected to seek nearly $550 billion in cuts to Medicaid spending, with the [...]

joe2025-04-24T14:45:26-04:00April 24, 2025|340b, Centers for Medicare & Medicaid Services, Congress, hospitals, Medicaid, Medicaid managed care, Medicare, Medicare reimbursement policy|