Work and Community Engagement Requirements in Medicaid: State Implementation Requirements and Considerations
Patricia Boozang, Allison Orris, Mindy Lipson, and Deborah Bachrach, Manatt Health
In January 2018, the Centers for Medicare & Medicaid Services (CMS) released a State Medicaid Director Letter providing guidance to states as to the circumstances under which CMS would approve 1115 demonstration waivers making work/community engagement (CE) requirements a condition of Medicaid eligibility. Since then, CMS has approved state work/CE waivers in Arkansas, Indiana, Kentucky, and New Hampshire, and additional states have submitted or are poised to submit similar waivers. Manatt Health has produced a series of charts that outline the legal, policy, financial and operational tasks and issues that states will face in adding a work/CE condition to their Medicaid program.
If you are interested in only one of the charts, they are also available as individual resources:
State Health and Value Strategies also recently hosted a webinar, Explaining the Stewart v. Azar Decision and Implications for States, that provided an overview of the Stewart v. Azar decision and its potential implications for states with approved, pending or planned Medicaid waivers that include work/community engagement requirements.
On October 4, 2024, the Centers for Medicare & Medicaid Services released its proposed Notice of Benefit and Payment Parameters for 2026. This annual rule governs core provisions of the Affordable Care Act. This expert perspective focuses on provisions of the proposed rule of interest to state officials.
The new 2023 estimates from the American Community Survey provide national and state-level insurance coverage estimates, but do not fully reflect the Medicaid unwinding. Despite this limitation, the data are instructive about changes to coverage during the early months of the unwinding period and generally for the year 2023. This expert perspective examines insurance coverage for children and adults, including uninsurance rates for children by state and income level.
As the 2024 open enrollment period approaches, template social media resources are available to assist states in their outreach efforts. The resources are designed to help states effectively promote important information about Marketplace enrollment and health plan options to consumers, including those who may have lost Medicaid coverage earlier this year.