Medicaid Work and Community Engagement Requirements

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April 2019 | Waivers

A number of states have requested Section 1115 waiver authority to impose work and community engagement requirements as a condition of Medicaid eligibility.  The Centers for Medicare & Medicaid Services (CMS) has granted waivers to ten states—Arizona, Arkansas, Indiana, Kentucky, Maine, Michigan, New Hampshire, and Ohio, Utah, and Wisconsin—to adopt work and community engagement requirements and has issued subregulatory guidance indicating the circumstances under which it will approve similar requests. Wavier approvals for Arkansas and Kentucky were vacated and remanded to the U.S. Department of Health and Human Services for further review by the U.S. District Court for the District of Columbia. This action leaves the future of work requirements in these states in question, although neither state may enforce them at this time.

This issue brief describes the features of the CMS guidance and state proposals, including the populations subject to the requirements, the allowable work and community engagement activities, and the penalties associated with non-compliance. It also describes implementation considerations CMS has requested that states take into account as well as monitoring, evaluation, and process requirements. It concludes by outlining some of the concerns raised regarding the imposition of such requirements.

Publication Type: Issue Briefs

Tags: adults, childless adults, eligibility, new adult group, Section 1115 research and demonstration project waivers