2. State Implementation

The WFTC legislation establishes specific requirements for State implementation of community engagement. These requirements include addressing the timing and standards for the implementation date, outreach processes, demonstration of good-faith effort, and conflict of interest safeguards with manage care plans. While this IFC aligns accordingly with these requirements, we believe that additional explanation is necessary for certain provisions to assist States in implementing them more efficiently.

Section 435.561(b)(1) and (2) newly requires States to send notices to beneficiaries 4, 5, or 6 months prior to the community engagement requirement becoming effective in the State and to beneficiaries who apply and enroll after the initial outreach notice is sent, but before the community engagement requirement becomes effective in the State. This will ensure beneficiaries who newly enroll in the adult group described at § 435.119 or an applicable section 1115 demonstration will be made aware of the requirement.

We also require States to notify all individuals described in § 435.561(a) on a periodic basis thereafter and outline when States must provide outreach notices through at least two modalities on an ongoing basis at § 435.561(d). Under the authority given to the Secretary to specify standards for outreach notices, we define “periodic basis thereafter” to mean that for individuals described in § 435.561(a) outreach notices must be provided: (1) following a determination or redetermination of eligibility at application, at renewal described at section 1902(e)(14)(L) of the Act and § 435.916, and based on a change in circumstances; (2) when the State elects the short-term hardship exception in the State plan under § 435.555(a) and each time the State effectuates a short-term hardship event described in § 435.555(d)(2) and (3) (except for an occasion included as part of the State plan election) and (3) upon request by CMS, if State reported monitoring data described at § 435.562 or other information indicate a potential compliance issue with §§ 435.550 through 435.562. We believe this will allow States to align outreach notices with eligibility determination notices under § 435.917, since States must already provide information to individuals about their eligibility and rights and responsibilities. For example, States may align such notices by combining the content of the outreach notice with the eligibility determination notice or send a separate outreach notice when an eligibility determination notice is issued. We also believe this approach will allow States to keep individuals updated about changes in the State's short-term hardship exception policy with less burden by utilizing the outreach process already required by section 1902(xx)(8) of the Act. Finally, we believe that this will allow States to provide additional outreach, if requested by CMS, when States' community engagement monitoring data indicate potential problems or concerning trends, such as if a State is experiencing large shifts in month-over-month determination and redetermination outcomes, or greater disenrollments for procedural denials compared to other States. For more information about monitoring data States must submit and our approach to identify potential compliance issues ( printed page 33467) that could result in additional outreach, see section II.O. of this IFC. While we are requiring States to conduct ongoing, periodic outreach each time an individual described at § 435.561(a) is provided an eligibility determination notice, States may choose to conduct additional outreach to individuals on an ad hoc or routine basis.

We considered defining outreach on a “periodic basis thereafter” to mean that States must conduct outreach upon enrollment for applicants determined eligible and at least every 6 or every 12 months thereafter for beneficiaries described at § 435.561(a) to provide a consistent time frame for all beneficiaries to receive outreach. While such a definition would provide consistency for all individuals and across all States, we recognize this could result in outreach that may not be meaningful as it was not necessarily aligned with the timing of the eligibility information that must already be provided when someone receives an eligibility determination notice. We also considered specifying when States should conduct periodic outreach in 2027 and 2028 or the first 2 years of implementation and then later permitting States to determine how frequently periodic outreach should occur after the first few years of implementation. While this would allow States to determine when it would be most effective to conduct outreach, we were concerned that this may increase the likelihood that CMS would need to request additional outreach based on monitoring data if States did not conduct outreach frequently enough.