The Trump administration announced additional requirements for how states will comply with work requirements for Medicaid participants established under last year’s tax and spending package.
Under the interim final rule issued Monday, able-bodied Medicaid beneficiaries over the age of 18 will be required to document that they’ve completed at least 80 hours per month of work or community service, or be enrolled in an education program starting Jan. 1, 2027.
The work requirements will exclude parental guardians or family caregivers of young children and people with disabilities, disabled veterans, those who are medically frail or disabled, pregnant women, and inmates. Temporary exemptions will also be given for adults facing “short-term hardship events” such as natural disasters or extended hospital care.
The rule lays out data reporting requirements and notes how states need to assess compliance. The Centers for Medicare & Medicaid Services in a press release said the efforts “are expected to promote transparency, reduce administrative burden, and ensure states provide clear, actionable guidance to new applicants and Medicaid beneficiaries on how to meet the new eligibility requirement.”
“This rule helps Americans build skills and independence through work, education, job training, or community service, creating new opportunities for themselves and their families,” CMS Administrator Mehmet Oz said in a statement.
Also in the rule are details on who qualifies as “medically frail.” CMS in the rule said it was “not providing States with the option to add additional categories of people to the definition of medical frailty for community engagement purposes.”
“We are concerned that there may be more of an incentive for some States to include individuals who would not reasonably be considered medically frail, if we provided States with the option to add additional categories of people to the community engagement medically frail definition,” CMS said.
Healthcare advocacy group Protect Our Care in a statement said the guidance “creates a labyrinth of paperwork, reporting mandates, and rigid eligibility rules designed to ensure people lose health care, even when they should qualify to keep it.”
Kate McEvoy, executive director of the National Association of Medicaid Directors, said the group “is reviewing the interim final rule and working with our members to understand its implications, including the definitions for key exemptions, data-matching requirements, and operational considerations. State and territory Medicaid agencies are on the front lines of implementation, and their input will shape NAMD’s response.”
The Centers for Medicare & Medicaid Services will allocate $200 million to carry out the necessary infrastructure changes. States will also be offered a temporary deadline extension if they demonstrate a good-faith effort at compliance, though noted they’re “intended to be short-term in nature.”
“CMS expects to approve initial requests for no longer than 6 months. However, we may grant extensions, until no later than December 31, 2028, provided that the State continues to demonstrate a good faith effort to meet all applicable requirements,” the rule said.