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 four states—Arkansas, Indiana, Kentucky, and New Hampshire—to adopt work and community engagement requirements and has issued subregulatory guidance indicating the circumstances under which it will approve similar requests. Kentucky’s waiver approval was 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, and the state is not moving ahead with implementation 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