1. Work

Under section 1902(xx)(2)(A) of the Act, an applicable individual demonstrates community engagement if the individual works not less than 80 hours in such month. At new § 435.552(b), we define work to mean: work in exchange for money, work in exchange for goods or services (“in-kind” work), and unpaid work other than community service (as defined and discussed below). Applicable individuals can work in one or more ways, separately or combined, to meet the community engagement requirement. Work in exchange for money can include many occupations. However, an individual does not need to be an employee of a company or organization to meet this definition. Section 1902(xx)(2) of the Act does not specify particular work arrangements; rather, it requires that individuals engage in meaningful activity in the community, including working. Many individuals work for themselves by being self-employed due to starting a business, owning a business, or as an independent contractor, and these activities meet the definition of work at § 435.552(b).

In-kind and unpaid work also represent ways in which an individual can engage in meaningful activity in the community. With a broad definition of work, we recognize the reality of the wide array of work arrangements and seek to enable individuals participating ( printed page 33355) in such arrangements to demonstrate community engagement. There are jobs in various sectors, ranging from domestic service to specialized facility management, where individuals may choose to accept in-kind compensation in the form of non-monetary benefits like housing, meals, or utilities. For example, an individual who performs duties as a property manager or building superintendent may receive compensation in the form of free or reduced rent. Under our definition of work at § 435.552(b), the hours the individual spends performing these duties would count toward meeting the 80-hour requirement.

Unpaid and in-kind work are also a way for individuals to obtain necessary job skills and gain work experience prior to attaining paid employment. Our definition of work, which does not require that an individual receive payment for duties or activities performed for the benefit of another individual or entity, accommodates situations where individuals engage in unpaid work, including, but not limited to, unpaid work as part of a trial period when applying for a job, or unpaid work, such as an internship, to gain experience for a job or industry. In contrast to community service (discussed in section II.C.2. of this IFC), unpaid work can benefit an individual or private entity and does not need to benefit the community. For example, an individual can intern at a private office to gain experience with bookkeeping and records management, but this internship would not be community service.

The unpaid work of a family caregiver as defined at § 435.554(a), who does not qualify as a specified excluded individual, can also qualify as unpaid work under the definition at § 435.552(b). We recognize that not all people who meet the definition of a family caregiver will qualify as a specified excluded individual under section 1902(xx)(9)(A)(ii)(III) of the Act, which this IFC implements at § 435.554. Caregiving hours that are below the 80-hour caregiving threshold in § 435.554(c)(3)(i)(C) and are provided by a family caregiver as defined at § 435.554(a) to a dependent child 13 years of age and under or a disabled individual, with whom he or she does not reside and is not related to, would count toward demonstrating community engagement. For additional details about implementation of the family caregiver definition and the criteria to qualify as a specified excluded individual, see sections II.E.3.d. and h. of this IFC.

Including in-kind and unpaid work in the definition of work generally aligns with the Food and Nutrition Service's (FNS) regulatory definition of working for SNAP at 7 CFR 273.24 , which implements the work requirement in title VIII of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 ( Pub. L. 104-193 ) enacted on August 22, 1996 (PRWORA). Similar to section 1902(xx)(2)(A) of the Act, PRWORA also does not define work. FNS developed the definition to include in-kind and unpaid work. [ 29 ] We are adopting a similar definition for purposes of Medicaid community engagement, in keeping with our principle of aligning with other existing public benefit work requirements to the extent possible.

States will need to verify work hours when determining compliance under § 435.552(a). Additional information about verification is discussed in section II.I.6.a. of this IFC.