What Do the Medicaid Community Engagement Requirements Mean for Medicaid Managed Care and Provider Operations?

The useful part

Many stakeholders were surprised by the Interim Final Rule, especially with respect to its treatment of the "medically frail exemption," which CMS narrowed significantly compared to OBBA statutory text. CMS's interpretation of this exemption and its subsequent implementation will likely have significant impacts on states, hospitals, Medicaid managed care organizations (MCOs), and other providers. Interim Final Rule Overview Overall, the Interim Final Rule's primary purpose is to require Medicaid applicants and enrollees to meet an 80 hour per month work requirement.

How it works

• The work requirement allows individuals to attain the 80 hour per month requirement through community service, education, employment, participation in a work program, or a combination of these activities.
• Individuals may also satisfy the requirement through earnings equal to at least 80 hours at the applicable federal minimum wage, and certain seasonal workers may qualify based on their average income over...
• This requirement generally applies to the "adult group" or Medicaid enrollees ages 19-65 that are not pregnant and do not otherwise meet another Medicaid eligibility category.