Overview
- CMS issued interim guidance Monday that spells out how states must enforce an 80-hour-per-month work, school or community-engagement test for many adults on Medicaid.
- The rule lists specific exemptions for people who are pregnant or postpartum, caregivers, American Indians and Alaska Natives, those already meeting SNAP work rules, and people judged medically frail under a two-part test tying diagnostic categories to significant functional impairment.
- States may accept self-attestation of compliance through 2027 but must require documentation and stricter verification beginning in 2028, and CMS is building a federal data tool called Emmy to help states check records while offering about $200 million in implementation grants.
- The guidance bars states from using managed-care organizations to verify compliance, forbids 'lock-out' waiting periods after noncompliance, requires states to submit eligibility and processing data to CMS, and estimates significant state system upgrade costs.
- Democrats, patient advocates and hospitals warn the rules and new paperwork will drive coverage losses and administrative churn, with nonpartisan analyses projecting millions could lose coverage over time and legal and political challenges likely to follow.