The Centers for Medicare & Medicaid Services’ (CMS) new interim final rule will implement “a new statutory requirement for certain adults in Medicaid to meet an 80-hours-per-month work requirement — sometimes referred to as Medicaid community engagement — as a condition of eligibility.”
In its June 1 announcement, CMS said states “must generally implement this requirement no later than Jan. 1, 2027.”
The work requirement will apply “to non-pregnant adults between the ages of 19 and 64 who are not entitled to or enrolled in Medicare and are eligible for or enrolled in the Medicaid adult group or in certain section 1115 demonstrations that provide minimum essential coverage to adult beneficiaries.”
Medicaid beneficiaries “will be required to demonstrate 80 hours per month of qualifying activities, such as employment, participation in certain work programs, or community service, or be enrolled in educational programs at least half time,” CMS said. “Certain new Medicaid applicants will need to meet the requirement for at least one month before the month in which the applicant applies, and existing Medicaid beneficiaries will need to meet the requirement for one or more months between renewals.”
Documentation requirements for states
States will need to confirm beneficiaries’ compliance when patients apply for Medicaid coverage and when they renew coverage, though states can also check compliance more frequently.
“If a state cannot verify that an individual has met the requirement, it must send a notice of noncompliance and provide the individual with 30 calendar days to demonstrate compliance or that the requirement does not apply to them,” CMS said. “If the individual fails to do so, their application might be denied or they might be disenrolled from Medicaid.”
Adults exempt from the new rule include former foster care youth; American Indians and Alaska Natives; parents, guardians, caretaker relatives, or family caregivers of a dependent child 13 years of age and under, or of a disabled person; veterans who have a total disability rating; adults deemed “medically frail or who otherwise have special medical needs that significantly impair their ability to comply with the requirement”; adults meeting Temporary Assistance for Needy Families (TANF) work requirements or are in a household receiving Supplemental Nutrition Assistance Program (SNAP) benefits and are not exempt from the SNAP work requirements; adults in drug or alcohol rehabilitation/treatment programs; inmates in public institutions; and adults who are pregnant or eligible for postpartum coverage in their state.
Responsibilities of states
Under the new interim rule, states will be required to determine who is and is not subject to the new work requirement; to identify beneficiaries who have exceptions; to confirm beneficiaries who are subject to work requirements meet the requirement at application and renewal times; to provide educational outreach and notice to affected beneficiaries and applicants; to follow through with required steps when beneficiaries or applicants are noncompliant or when compliance cannot be verified; and to submit data to CMS “to support monitoring and program integrity.”
“CMS is issuing new reporting requirements and will use existing data reporting systems to monitor state implementation,” the agency added. “States that fail to submit required data or show compliance issues may be subject to corrective action.”
Interim rule provisions are effective July 31, 2026. Public comments on the rule are due on that date as well.
