RCPA has compiled information for our members from our partners at the
National Council for Mental Wellbeing as well as Wojdak Government Relations regarding CMS’ release of its interim final rule regarding work requirements.
From the National Council for Mental Wellbeing:
On June 1, the Centers for Medicare and Medicaid Services (CMS) released its
interim final rule on implementing community engagement requirements (commonly referred to as “work requirements”) as provided under H.R.1. Additional information on the proposal can be found in the
press release and
fact sheet.
Because CMS released an
interim final rule, the rule will be effective July 31, 2026, with an opportunity for public comment, due July 31, 2026.
Background:
H.R.1 requires expansion enrollees, non-pregnant adult Medicaid beneficiaries aged 19-64 who typically meet a higher income threshold than in traditional Medicaid and receive coverage in their state as a result of
Medicaid expansion or waiver, complete at least 80 hours of work or qualifying activities per month. Other qualifying activities can include community service, work programs, educational programs, or a combination of these activities.
The law provides exemptions to meeting these requirements for those who are “medically frail,” which includes individuals with a substance use disorder, disabling mental disorder, or those participating in a Drug Addiction or Alcoholic Treatment or Rehabilitation Program. The Interim Final Rule seeks to provide further implementation guidance on these exemptions.
Unless the Secretary grants an extension, states are required to implement work requirements by Jan. 1, 2027, with some states choosing to implement these requirements sooner (so far this includes Nebraska, Montana, Arkansas, and Iowa).
From Wojdak Government Relations:
Key Provisions on Requirements and Activities:
Beginning January 1, 2027, (or earlier date chosen by the state) states must require that certain adults meet a work requirement to enroll in Medicaid or keep their Medicaid coverage when their eligibility is renewed. The work requirement applies to "applicable individuals" or 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.
States must conduct outreach to adults who are already enrolled in Medicaid and could be subject to the requirement prior to implementing the new requirement. States must also continue to conduct outreach to applicants who enroll in Medicaid or those whose coverage is renewed on a basis that is subject to meet these requirements after implementation.
Work Requirement Activities:
Adults subject to the work requirement can meet the requirement for a month if they:
- Work, complete community service, or participate in a work program for not less than 80 hours;
- Enroll in an educational program at least half-time;
- Complete a combination of the activities described above for at least 80 hours; or
- Have monthly income that is not less than the federal minimum wage multiplied by 80 hours.
Some adults are considered to meet the requirement because they were under the age of 19, were enrolled in another Medicaid eligibility group or Medicare, were previously an inmate, or were previously exempt from the requirement.
Key Provisions on Exemptions:
Some adults are exempt and do not need to meet the work requirement to enroll in Medicaid or keep their Medicaid coverage, including adults who are:
- 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 a disabled individual;
- Veterans with a total disability rating;
- Medically frail or otherwise have special medical needs that significantly impair their ability to comply with the requirement;
- Meet the TANF work requirements or are a member of a household receiving SNAP benefits and are not exempt from the SNAP work requirements;
- Participants in a drug or alcohol rehabilitation or treatment program;
- Inmates of a public institution; and
- Pregnant or eligible for postpartum coverage in their state.
Key Provisions on Exceptions and Assessing Community Engagement:
States have the option to provide short-term hardship exceptions that allow an individual to be considered as meeting the work requirement. The short-term hardships offered, when states choose this option, are for adults:
- Receiving certain medical services, such as inpatient hospital or nursing facility services;
- Residing in a county in which there is an emergency or disaster declared by the President;
- Residing in a county with a high unemployment rate; or
- Traveling outside of their community for an extended period of time for medical services for a serious or complex medical condition for themselves or their dependent.
Adults must meet the work requirement at application and during periodic renewals of eligibility. States determine how many months an individual must meet the requirement, and they have the option to conduct more frequent verifications that individuals meet the work requirement between renewals.
If a state cannot verify someone meets the requirement, they must provide the individual 30 days to show the state that they meet the requirement or that they are exempt. If someone is disenrolled because they did not meet the work requirement, they may reapply for Medicaid coverage.
From RCPA:
RCPA and the National Council for Mental Wellbeing will continue to further review and analyze this rule, develop comments, and provide members with timely updates and resources as state implementation moves forward. RCPA will be releasing its H.R. 1 Medicaid Resource Handbook in the coming week that includes the National Council for Mental Wellbeing’s
H.R.1 Hub. RCPA thanks our partners for their assistance in providing updates for our organization and members.
