a. Pending Applications and Implementation of the Community Engagement Requirement

Upon implementation, a State will have applications that were submitted before implementation of the community engagement requirement and for which eligibility determinations have not yet been made. These pending applications must be adjudicated according to the policies in place on the date the application was submitted, consistent with § 435.915, which provides that the effective date of Medicaid coverage is based on the date an application is submitted. If applicable individuals included on such an application are determined eligible and enrolled, the State must then apply the new community engagement requirement to these individuals in accordance with requirements for ( printed page 33416) enrolled beneficiaries discussed in the next section.

As an illustrative example, consider a State that has an implementation date of January 1, 2027. The State requires that an applicable individual demonstrate community engagement in the month before the month of application and does not elect to conduct more frequent verifications of community engagement. An application for medical assistance that is submitted on December 15, 2026, must be adjudicated based on the eligibility rules in place on December 15, 2026, even if an eligibility determination is not made until January 15, 2027 (after the implementation date). Since the community engagement requirement was not in place at the time of application, the State must not evaluate whether the individual is an applicable individual and whether the individual demonstrated community engagement in November 2026, the month before the month of application. If the person is determined eligible and enrolled in Medicaid, then the applicability of the community engagement requirement and the individual's compliance with the requirement will be evaluated as part of the person's next scheduled periodic renewal of eligibility. However, the individual must be notified of the community engagement requirement when they enroll in coverage, in accordance with the outreach requirements in section II.L. of this IFC and § 435.561.