To amend title XIX of the Social Security Act to establish a community engagement requirement for certain individuals under the Medicaid program.
This bill would add a new “community engagement” requirement for a subset of Medicaid enrollees, termed “applicable individuals.” Each month, an applicable individual would have to meet one of several activity options totaling at least 80 hours per month (roughly 20 hours per week): paid work at or above 80 hours times the federal minimum wage, 80 hours of community service, participation in a work program, or any combination totaling 80 hours. If an individual fails to meet the requirement for three or more months in a calendar year while enrolled in a state Medicaid plan, the federal match for medical assistance for that month could be denied, and states would have the option to disenroll the individual for that month. The bill also sets out verification methods, defines who counts as an applicable individual and related terms (like what counts as an educational program and what is a work program), and allows states to disenroll for months with no federal funding participation. States would implement these rules through their Medicaid programs and waivers. In short, the bill ties Medicaid eligibility and ongoing federal funding to monthly community engagement activities for a broad adult Medicaid population, with built-in exemptions, verification procedures, and a state option to disenroll for months with no federal funding participation.
Key Points
- 1Community engagement standard: For an applicable individual and a given month, compliance can be met by (A) working 80+ hours per month (at or above the equivalent of minimum wage for 80 hours), (B) completing 80+ hours of community service per month, (C) participating in a work program for 80+ hours per month, or (D) combining work, community service, and a work program to total at least 80 hours per month.
- 2Who is an “applicable individual”: Adults 18–65 who are not physically or mentally unfit for employment (per a medical professional), not pregnant, not the parent or caregiver of dependent or incapacitated individuals, not already complying with work requirements in another federal program, not enrolled in an educational program at least half time, and not in certain treatment programs. Educational programs include higher education, career/technical education, or other Secretary-approved programs.
- 3Verification and administration: States should use existing data sources (e.g., USPS National Change of Address, state health and human services databases, payroll data) to verify engagement before seeking additional verification, reducing the burden on individuals where possible.
- 4Financial participation and disenrollment: If an applicable individual’s month lacks federal financing for medical assistance (because of three or more preceding months of noncompliance in the same calendar year), the state may disenroll the individual for that month and federal financial participation may not be available for that month.
- 5State flexibility: The bill gives states the option to disenroll an applicable individual for months when no federal financial participation would be available, allowing some state-level discretion in implementation.