New CMS Framework Guides Medicaid Work Requirement Implementation
New CMS Framework Guides Medicaid Work Requirement Implementation
The Centers for Medicare and Medicaid Services has released an Interim Final Rule with Comment Period that sets a nationwide framework for how states must handle a new Medicaid work requirement. Under this rule, certain adult Medicaid applicants and enrollees between the ages of 19 and 64 will need to complete at least 80 hours of qualifying activity per month to remain eligible for coverage. Those activities can include employment, education, job training programs, or community service.
Centers for Medicare and Medicaid Services Administrator Dr. Mehmet Oz spoke about the intent behind the rule, saying it is meant to help Americans build skills and independence while creating new opportunities for themselves and their families.
The rule was issued under Public Law 119-21, which the Centers for Medicare and Medicaid Services refers to as the Working Families Tax Cut legislation. It lays out clear standards for states to follow, covering eligibility determinations, exemptions, verification processes, and reporting requirements.
Not everyone will be subject to the requirement. The rule carves out exemptions for pregnant and postpartum individuals, people with disabilities, those who are medically frail, American Indian and Alaska Native individuals, parents or caregivers of young children or people with disabilities, and those already meeting similar requirements through the Supplemental Nutrition Assistance Program or Temporary Assistance for Needy Families.
A study from the Department of Health and Human Services found that depending on employment conditions, the new requirements could lift as many as 2.9 million people out of poverty.
To help states get ready, the Centers for Medicare and Medicaid Services is providing $200 million in Government Efficiency Grants authorized under the Working Families Tax Cut legislation for system modernization, along with more than $600 million in committed support from private sector technology vendors to help update eligibility and enrollment systems.
States have until January 01, 2027 to have the requirement in place, though some states like Nebraska have already moved forward with early implementation. The public comment period remains open while the rule is being put into effect.
To view the IFC on the Federal Register, visit: https://www.federalregister.gov.
