New Policy Guidance Issued to Improve Medicaid Beneficiary Enrollment

To support efforts to improve Medicaid enrollee health outcomes by incentivizing community engagement among able-bodied, working-age Medicaid beneficiaries, the Centers for Medicare and Medicaid Services (CMS) is providing new policy guidance to help states design demonstration projects that promote the objectives of the Medicaid program and are consistent with federal statutory requirements. The guidance is in response to state requests to test programs through these projects in which work or participation in other community engagement activities, including skills training, education, job search, volunteering or caregiving, would be a condition for Medicaid eligibility. However, this condition would not apply to individuals with a disability, elderly beneficiaries, children and pregnant women.

Specifically, CMS has identified a number of issues for states to consider:

• Because of areas of high unemployment or caregiving for young children or elderly family members, states will be required to describe strategies to assist eligible individuals in meeting work and community engagement requirements and to link individuals to additional resources for job training, provided they do not use federal Medicaid funding to finance those services.
• States should align their efforts with Supplemental Nutrition Assistance Program or Temporary Assistance for Needy Families requirements, where appropriate.
• Federal disability and civil rights laws must be fully complied with to ensure all individuals with disabilities have the necessary protections to ensure they are not inappropriately denied coverage. In addition, states will be required to offer reasonable modifications to individuals with disabilities, and will be required to exempt individuals determined to be medically frail or who have an acute condition that a medical professional has determined will prevent them from complying with the requirements.
• States will be required to make reasonable modifications for individuals with opioid addiction and other substance use disorders. These modifications may include counting time spent in medical treatment toward an individual’s community engagement requirements or exempting individuals participating in intensive inpatient or outpatient medical treatment, as well as supporting other state efforts.
• States are encouraged to consider a range of activities that could satisfy work and community engagement requirements such as career planning, job training, referral and volunteering opportunities, as well as job support services offered in connection with the requirement, and they should take into account people’s employability and potential contributions to the labor market.

“States have the opportunity to help individuals improve and enhance the skills that employers truly value,” said Seema Verma, CMS administrator. “People who participate in activities that increase their education and training are more likely to find sustainable employment, have higher earnings, a better quality of life, and, studies have shown, improved health outcomes.”