CMS has announced a new initiative allowing states to propose demonstrations to "improve Medicaid enrollee health and well-being through incentivizing work and community engagement." Specifically, states may propose Section 1115 waivers to make participation in work or other community engagement a requirement for continued Medicaid eligibility or coverage for non-elderly, non-pregnant adult Medicaid beneficiaries who are eligible for Medicaid on a basis other than disability.  CMS explains the criteria it will use to evaluate state proposals, including:  alignment with Temporary Assistance for Needy Families (TANF) and Supplemental Nutrition Assistance Program (SNAP) programs; population subgroups included in the demonstration (including observance of all federal civil rights laws); the proposed range of activities that would satisfy the work and community engagement requirement; the proposed beneficiary supports in meeting the new requirements; and local employment market conditions.  CMS also specifies that any section 1115 waiver program must be budget neutral; states will not be permitted to accrue savings from an associated reduction in enrollment.

The day after announcing the new Medicaid option, CMS approved a Kentucky waiver allowing the state to implement a community engagement requirement as a condition of eligibility for Medicaid beneficiaries aged 19 to 64, with a number of exceptions (former foster care youth, pregnant women, primary caregiver of a dependent, beneficiaries considered medically frail, certain beneficiaries with acute medical conditions, and full time students).  To remain eligible for coverage, non-exempt Medicaid recipients in Kentucky must complete 80 hours per month of community engagement activities (e.g., employment, education, job skills training, and community service).

This article is presented for informational purposes only and is not intended to constitute legal advice.