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us/regulation/recovery/release-scope-us-regulation-2026-06-03-cms-2454-ifc-42-cfr-conforming-amendments — release scope us regulation 2026 06 03 cms 2454 ifc 42 cfr conforming amendments · Axiom
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release scope us regulation 2026 06 03 cms 2454 ifc 42 cfr conforming amendments
Rule
Rule
Medicaid Program; Community Engagement Requirement for Certain Individuals
Centers for Medicare & Medicaid Services
Agency:
Action:
Summary:
Dates:
Addresses:
For Further Information Contact:
Supplementary Information:
Table of Contents
A. Overview
B. Working Families Tax Cut Legislation
C. Severability
II. Provisions of the Interim Final Rule With Comment Period
A. Decision to Revise Certain Eligibility and Enrollment Regulations To Implement Community Engagement
B. Applicable Individuals
C. Demonstrating Community Engagement
1. Work
2. Community Service
3. Work Program
4. Educational Program
5. Enrollment in an Educational Program at Least Half-Time
6. Enrollment in an Educational Program Less Than Half-Time
7. Combination of Activities
8. Monthly Income and Average Monthly Income for Seasonal Workers
D. Mandatory Exceptions for Certain Individuals
E. Specified Excluded Individuals
1. Former Foster Care Children
2. American Indians
3. Parent, Guardian, Caretaker Relative, or Family Caregiver of a Dependent Child 13 Years of Age and Under or a Disabled Individual
a. Definition of Caretaker Relative
b. Definition of Parent
c. Definition of Guardian
d. Definition of Family Caregiver
e. Definition of Dependent Child
f. Definition of Disabled Individual
g. Applicability of Parent, Caretaker Relative, Guardian, or Family Caregiver Exclusion to Multiple Individuals in a Residence
h. Criteria for the Family Caregiver Exclusion
4. Veteran With a Disability Rated as Total
a. Background
b. Medically Frail Definition
6. Individuals Compliant With TANF Work Requirements and Individuals Not Exempt From SNAP Work Requirements
7. Participant in a Drug or Alcohol Rehabilitation or Treatment Program
8. Inmate of a Public Institution
9. Pregnant or Entitled to Postpartum Coverage
F. Mandatory Exceptions vs. Specified Excluded Individuals
G. Short-Term Hardship Exceptions
1. Scope of the Election and Certain Notice Requirements
2. Procedures for Implementing Short-Term Hardship Exceptions
3. Definition of a Short-Term Hardship Event
4. Applicable Individuals in Certain Medical Institutions or Receiving Outpatient Services
5. Emergency and Disaster Areas
6. Areas With Certain Levels of Unemployment
7. Applicable Individual or Dependent Must Travel Outside of Their Community for an Extended Period of Time To Receive Medical Services Necessary for a Serious or Complex Medical Condition
H. Assessing Compliance With the Community Engagement Requirement
1. Assessing Applicability of the Community Engagement Requirement
2. Assessing Compliance for Applicants
3. Assessing Compliance for Enrolled Beneficiaries
a. Assessing Compliance at Renewal if the State Does Not Elect To Conduct More Frequent Verifications of Compliance With the Community Engagement Requirement
b. Assessing Compliance When the State Conducts More Frequent Verifications of Compliance With the Community Engagement Requirement
c. Prohibition on Assessing Compliance With Community Engagement for Specified Excluded Individuals
d. Processing Certain Changes in Circumstances
(1) Changes in Circumstances for Beneficiaries Enrolled on Another Basis Who Become Eligible for a Group Subject to the Community Engagement Requirement
(2) Changes in an Individual's Status as a Specified Excluded Individual
e. Notifying Individuals About Eligibility Decisions and Changes in Eligibility Requirements
I. Verification of Compliance With and Exceptions and Exclusions From the Community Engagement Requirement
1. Requirement To Conduct Ex Parte Verification
2. Requirement To Use Reliable Information Available to the State
3. Requesting Additional Information From Applicants and Beneficiaries To Verify Compliance With, and Exceptions and Exclusions From, the Community Engagement Requirement
a. Requirement To Accept Information From Applicants and Beneficiaries
4. Verifying Community Engagement at Application, Renewal and More Frequent Verifications
a. Verifying Community Engagement Information Provided on an Application, Renewal Form, or Reported Between Regular Renewals
b. Verifying Community Engagement When Conducting More Frequent Verifications Between Regularly Scheduled Redeterminations
5. The Federal Data Services Hub or Other Electronic Service
6. Verifying Compliance With Community Engagement Activities
a. Verifying Hours of Work
(1) Verifying Hours for Certain Caregivers
b. Verifying Community Service
c. Verifying Participation in a Work Program
d. Verifying Enrollment in an Educational Program
e. Verifying Compliance Using a Combination of Activities
f. Verifying Compliance Based on Monthly Income
7. Verifying Status as a Specified Excluded Individual
a. Former Foster Care Children
b. American Indians
c. Parent, Guardian, Caretaker Relative, or Family Caregiver of a Dependent Child or a Disabled Individual
d. Veterans with a Disability Rating as Total
e. Individuals Who Are Medically Frail or Otherwise Have Special Medical Needs
f. Individuals Compliant With TANF Work Requirements and Individuals Not Exempt From SNAP Work Requirements
g. Participants in Drug Addiction or Alcoholic Treatment and Rehabilitation Programs
h. Inmate of a Public Institution
i. Pregnant or Eligible for Postpartum Coverage
8. Mandatory Exceptions
9. Verifying Optional Short-Term Exceptions
a. Applicable Individuals in Certain Medical Institutions or Receiving Outpatient Services
b. Applicable Individual or Dependent Must Travel Outside of Their Community for an Extended Period of Time To Receive Medical Services Necessary for a Serious or Complex Medical Condition
c. Emergency and Disaster Declarations and High Unemployment Rate
J. Noncompliance Procedures
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