Medicaid eligibility

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|

Federal Health Policy Update for May 28

The following is the latest health policy news from the federal government for May 22-28. Some of the language used below is taken directly from government documents. Congress When Congress returns from the Memorial Day recess next week, lawmakers will have to address the Republican-led reconciliation bill to fund ICE and CBP. After, they plan to start working on a third party-line bill focusing on affordability—including health care—which leadership aims to pass by the end of July. Next week, the House Appropriations Subcommittee on Labor, Health and Human Services, Education, and Related Agencies is scheduled to mark up its Fiscal [...]

sysadmin2026-05-28T17:43:32-04:00May 28, 2026|Affordable Care Act, Centers for Medicare & Medicaid Services, Congress, MACPAC, Medicare, Medicare regulations, Medicare reimbursement policy|

Federal Health Policy Update for April 10

The following is the latest health policy news from the federal government for April 4-10. Some of the language used below is taken directly from government documents. Congress The House and Senate were in recess this week and are scheduled to be back in session on April 14. House Speaker Mike Johnson (R-LA) has indicated that the House will not vote on the Senate‑passed Department of Homeland Security continuing resolution until there is meaningful progress on a reconciliation package to fund U.S. Immigration and Customs Enforcement (ICE) and U.S. Customs and Border Protection. In an effort to narrow the scope [...]

joe2026-04-10T13:43:20-04:00April 10, 2026|340b, Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, CMMI, Congress, Medicaid, Medicare, Medicare disproportionate share, Medicare DSH, Medicare reimbursement policy|

Search for Undocumented Medicaid Participants Not Yielding Major Results

An administration effort to identify undocumented U.S. residents illegally enrolled in Medicaid is not turning up many undocumented residents illegally enrolled in Medicaid. At least not so far. Last fall, the administration sent the names of hundreds of thousands of suspected illegal Medicaid participants to the states and directed them to review the eligibility of those individuals. Data from five states, however, has not turned up many such individuals. Between them, Colorado and Pennsylvania reviewed 79,000 names and found none illegally enrolled in their state Medicaid programs. Texas reviewed 28,000 records and terminated 77 people from the program. Ohio checked [...]

joe2026-04-07T16:53:00-04:00April 9, 2026|Medicaid|

CMS Lays Out Medicaid Eligibility Redeterminations

More than eight months after passage of HR 1, the “One Big Beautiful Bill Act,” the Centers for Medicare & Medicaid Services has provided formal guidance to the states on how to redetermine Medicaid eligibility for certain Medicaid beneficiaries – a major part of the bill’s health care changes. Under that law, states must redetermine affected individuals’ continued Medicaid eligibility every six months beginning with renewals scheduled on or after January 1, 2027. CMS is giving states two options for redetermining Medicaid eligibility. They may: move an individual’s previously set 2027 renewal date to an earlier date in 2027 to space out [...]

joe2026-03-11T08:08:31-04:00March 11, 2026|Medicaid|

New Methodology Helps Facilitate Medicaid Renewals

When the end of the COVID-19 pandemic led to the end of the moratorium on Medicaid disenrollments, states faced a daunting challenge: how to redetermine eligibility for 90 million people on their Medicaid rolls. The challenge grew even greater when it appeared that significant numbers of people were losing their Medicaid eligibility not because they no longer met the program’s eligibility criteria but for procedural reasons such as inability to gather the information needed to demonstrate eligibility, incomplete applications, or missing application deadlines. To address this problem, the Centers for Medicare & Medicaid Services tried a different approach, working with [...]

joe2025-11-04T16:35:21-05:00November 5, 2025|Centers for Medicare & Medicaid Services, COVID-19, Medicaid|

Federal Health Policy Update for August 21

The following is the latest health policy news from the federal government for August 15-21. Some of the language used below is taken directly from government documents. Congress The House and Senate are in recess and will return to Washington D.C. on September 2. Funding for the federal government expires on September 30, as will a number of health care extenders, including for telehealth flexibilities, the Acute Hospital Care at Home program, the Medicare-dependent hospital and low-volume hospital programs, and delays to Medicaid disproportionate share (Medicaid DSH) allotments. In the fall, Congress is considering pursuing health care legislation along two [...]

joe2025-08-21T14:43:11-04:00August 21, 2025|Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, CMMI, Congress, COVID-19, hospitals, MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicaid disproportionate share, Medicaid DSH, Medicaid DSH allotments, Medicare, Medicare cuts, Medicare reimbursement policy, post-acute care, Telehealth|

The Coming Medicaid Work Requirement

Among the many Medicaid-related aspects of the recently enacted FY 2026 budget reconciliation bill – the One Big Beautiful Bill Act – is a new requirement that much of the Medicaid population be employed or participate in some acceptable form of “community engagement.” But how will the work requirement work? How will it be implemented and enforced? KFF has taken an in-depth look at this matter, reporting on such issues as: What the new law requires. The timeline for the work requirement’s implementation. How much money the states and the federal government stand to save by ending Medicaid How many [...]

joe2025-08-05T17:24:07-04:00August 6, 2025|Congress, Medicaid|

Federal Health Policy Update for May 15

The following is the latest health policy news from the federal government for May 9-15. Some of the language used below is taken directly from government documents. Congress: Reconciliation House Energy and Commerce Committee Charged with finding $880 billion in federal spending cuts over the next ten years, the House Energy and Commerce Committee this week produced legislative language to be included in a House reconciliation bill that would achieve that objective. The committee’s cost-cutting provisions include: Freezing state Medicaid provider taxes at their current level, prohibiting the establishment of new provider taxes, modifying the criteria CMS uses to determine [...]

joe2025-05-15T17:19:56-04:00May 15, 2025|Accountable Care Organization, ACO, Alternative payment models, Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, CMMI, Congress, deficit reduction, Medicaid, Medicaid disproportionate share, Medicaid DSH, Medicaid managed care, Medicaid regulations, Medicare, Medicare cuts, Medicare regulations, Medicare reimbursement policy|