HR 1’s Medicaid work requirements are set to begin Jan. 1. Despite CMS rolling out a framework in June, the work requirements have been met with pushback.
The requirements will apply to states that expanded Medicaid or have a similar waiver. Applicable beneficiaries will need to carry out community engagement — such as work or community service — for at least 80 hours per month. HR 1 also established six-month redeterminations for this population, picking up the pace from annual redeterminations that resumed after the pandemic.
‘Medically frail’
On Oct. 29, a Massachusetts federal judge ruled that CMS had overstepped with part of its “medically frail” definition, which determines who would qualify for an exemption from the work requirements. Along with several groups that HR 1 outlined, CMS added how those who are “medically frail” must have a condition that “significantly impairs the individual’s ability to comply with the community engagement requirement.” That latter part was vacated as unlawful.
The ruling stemmed from a lawsuit filed in June by 25 states and the District of Columbia, which challenged the frailty parameters. Despite the ruling, work requirements will still move forward on schedule. Plaintiff states will have a six-month grace period to avoid penalties as they implement the interim final rule.
In July, the judge declined to temporarily block pieces of CMS’ interim final rule on work requirements.
More pushback
In an Oct. 1 letter, five Democratic governors asked HHS Secretary Robert F. Kennedy Jr. to delay the Jan. 1 start date. The governors clarified they were not seeking to put off the work requirements indefinitely but needed more time to implement the rule.
A separate lawsuit from Medicaid beneficiaries and health organizations also challenged the “medically frail” provision. That lawsuit in a Maryland federal court is still ongoing.
Early action
However, some states have already been leaning in, and a few have rolled out HR 1’s work requirements early, such as Nebraska.
Meanwhile, the Nov. 3 midterm election may shape how Medicaid work rules are implemented. For example, even though Georgia has not fully expanded Medicaid, it instead has its alternative Pathways to Coverage program with its own work rules. The program’s current federal waiver expires at the end of the year, leaving the next governor to navigate the transition.
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