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Page 18 – CMCS Informational Bulletin Subchapter D – Increasing Personal Accountability Section 71119. Requirement for States to Establish Medicaid Community Engagement Requirements for Certain Individuals Section 71119 amends section 1902 of the Act by adding a new subsection (xx) under which, beginning January 1, 2027, states must condition Medicaid eligibility for “applicable individuals” on their demonstration of community engagement. Unless an exception or exclusion applies (see below), applicable individuals are 1) individuals eligible for or enrolled under the state plan in the Medicaid adult group under section 1902(a)(10)(A)(i)(VIII) of the Act; or 2) individuals who are eligible for or enrolled under a waiver of the state plan (including a section 1115 demonstration) that provides coverage that is equivalent to MEC42 and who have attained the age of 19 and are under 65 years of age, are not pregnant, are not entitled to, or enrolled for, benefits under Medicare Part A or Part B, and are not otherwise eligible to enroll under the state plan.43 States may elect an earlier implementation date and should contact CMS for more details. Certain individuals (“specified excluded individuals”) are excluded from the definition of “applicable individuals” and are therefore not subject to community engagement requirements. These individuals are: former foster care children;44 certain American Indians and Alaska Natives;45 parents, guardians, caretaker relatives, or family caregivers (as defined in section 2 of the RAISE Family Caregivers Act (Public Law 115-119)) of a dependent child under the age of 14 or a disabled individual; veterans with a total disability rating; individuals who are medically frail or who otherwise have special medical needs (as defined by the Secretary); 46 individuals who are already compliant with Temporary Assistance for Needy Families (TANF) work requirements; members of households that receive Supplemental Nutrition Assistance Program (SNAP) benefits who are not exempt from a SNAP work requirement; individuals who are participants in certain substance use disorder treatment and rehabilitation programs; inmates of a public institution; and pregnant women or individuals entitled to postpartum medical assistance.47 42 MEC is defined in the statute as follows: “as described in section 5000A(f)(1)(A) of the Internal Revenue Code of 1986 and determined in accordance with standards prescribed by the Secretary in regulations.” 43 Notably, this definition for purposes of section 1902(xx) of the Act will capture states that provide coverage through a section 1115 demonstration to all individuals, or only to some individuals, who are described in section 1902(a)(10)(A)(i)(VIII) of the Act. 44 Described in section 1902(a)(10)(A)(i)(IX) of the Act. 45 Specifically, the exclusion applies to an Indian or Urban Indian (as such terms are defined in paragraphs (13) and (28) of section 4 of the Indian Health Care Improvement Act); a California Indian described in section 809(a) of such Act; or those who have otherwise been determined eligible as an Indian for the Indian Health Service under regulations promulgated by the Secretary. 46 Including an individual: who is blind or disabled (as defined in section 1614 of the Act); with a substance use disorder; with a disabling mental disorder; with a physical, intellectual or developmental disability that significantly impairs their ability to perform one or more activities of daily living; or with a serious or complex medical condition. 47 Postpartum medical assistance is available under section 1902(e)(5) or (16) of the Act.