The Centers for Medicare & Medicaid Services (CMS) has issued an interim final rule with comment period to implement the Medicaid community engagement requirements mandated by Section 71119 of Public Law 119-21.
The rule applies primarily to certain adults enrolled in, or eligible for, Medicaid expansion coverage and individuals covered through certain Section 1115 demonstration programs that provide minimum essential coverage, while exempting or excluding specified populations, such as certain caregivers, pregnant individuals, adults who are medically frail, and American Indians and Alaskan Natives.
The rule establishes the federal framework states must use to verify participation in qualifying community engagement activities—including employment, education, job training, community service, or other approved activities—as a condition of Medicaid eligibility beginning January 1, 2027.
Key provisions include standards for beneficiary outreach and education, use of existing data sources to verify compliance before requesting documentation, short-term hardship exceptions, and periodic eligibility verification requirements.