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Medicaid Program; Community Engagement Requirement for Certain Individuals
Plain English Summary
The Medicaid program is introducing a new community engagement requirement that affects certain applicants and beneficiaries. Starting January 1, 2027, individuals will need to show that they are participating in community activities to qualify for Medicaid. This rule outlines what activities count, how to prove participation, and what happens if someone does not meet the requirement. Insurance agents should prepare to inform clients about these changes and help them understand what they need to do to maintain their Medicaid eligibility.
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This interim final rule with comment period (IFC) interprets and implements the community engagement requirement in Medicaid under section 1902(xx) of the Social Security Act. States are required to implement the new requirement no later than January 1, 2027. This IFC specifies the requirements and expectations for States, including the Medicaid applicants and beneficiaries who must demonstrate community engagement as a condition of their eligibility, the types of qualifying activities that satisfy the community engagement requirement, the criteria to meet an exception from the requirement (that is, be deemed compliant), and the criteria to meet a specified exclusion from the requirement. It also specifies requirements for verification of qualifying activities, outreach to affected populations, steps States must take if they determine individuals are noncompliant, and additional operational considerations for States. Finally, this IFC specifies implementation timing and establishes new State reporting requirements.