A number of states have requested Section 1115 waiver authority to impose work and community engagement requirements as a condition of Medicaid eligibility. Between 2017 and 2020, the Centers for Medicare & Medicaid Services (CMS) granted waivers to a number of states to adopt work and community engagement requirements and issued subregulatory guidance indicating the circumstances under which it would approve similar requests.
Work and community engagement requirements are not currently in effect in any state. Waiver approvals in several states were vacated and remanded to the U.S. Department of Health and Human Services for further review by the U.S. District Court for the District of Columbia. The Biden Administration has since withdrawn authority to implement work and community engagement requirements, or indicated that it plans to do so, in all states that received such an approval during the Trump Administration.
The information in issue brief is current as of June 2020. It describes the features of the CMS guidance and state proposals, including the populations subject to the requirements, the allowable work and community engagement activities, and the penalties associated with non-compliance. It also describes implementation considerations CMS has requested that states take into account, as well as monitoring, evaluation, and process requirements. It concludes by outlining some of the concerns raised regarding the imposition of such requirements.