Medicaid Program; Community Engagement Requirement for Certain Individuals

A Rule by the Centers for Medicare & Medicaid Services on 06/03/2026

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This document was corrected by a document published on 06/29/2026.

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Document Details Published Content - Document Details Agencies Department of Health and Human Services Centers for Medicare & Medicaid Services Agency/Docket Number CMS-2454-IFC CFR 42 CFR 431 42 CFR 435 42 CFR 438 42 CFR 457 42 CFR 600 Document Citation 91 FR 33348 Document Number 2026-11094 Document Type Rule Pages 33348-33482 (135 pages) Publication Date 06/03/2026 RIN 0938-AV98 Published Content - Document Details

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Document Details Published Content - Document Details Agencies Department of Health and Human Services Centers for Medicare & Medicaid Services Agency/Docket Number CMS-2454-IFC CFR 42 CFR 431 42 CFR 435 42 CFR 438 42 CFR 457 42 CFR 600 Document Citation 91 FR 33348 Document Number 2026-11094 Document Type Rule Pages 33348-33482 (135 pages) Publication Date 06/03/2026 RIN 0938-AV98 Published Content - Document Details

Document Dates Published Content - Document Dates Effective Date 2026-07-31 Dates Text Effective date: These regulations are effective on July 31, 2026. Published Content - Document Dates

Table of Contents Enhanced Content - Table of Contents This table of contents is a navigational tool, processed from the headings within the legal text of Federal Register documents. This repetition of headings to form internal navigation links has no substantive legal effect. AGENCY: ACTION: SUMMARY: DATES: ADDRESSES: FOR FURTHER INFORMATION CONTACT: SUPPLEMENTARY INFORMATION: Table of Contents I. Background 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 5. An Individual Who is Medically Frail or Otherwise has Special Medical Needs 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 1. Providing a Notice of Noncompliance 2. Defining “Unable To Verify” Compliance With the Community Engagement Requirement a. Defining “Unable To Verify” at Application b. Defining “Unable To Verify” at Renewal Option 1 Option 2 c. Defining “Unable To Verify” During More Frequent Verifications of Compliance With Community Engagement Option 1 Option 2 3. Content and Timing of the Noncompliance Notice 4. State Responsibilities When There Is No Satisfactory Showing of Compliance 5. Reenrollment and Reconsideration Periods 6. Noncompliance Procedures and Ensuring Timely Eligibility Determinations at Application 7. Impact of Noncompliance and Eligibility for Financial Assistance for Coverage on a Health Insurance Exchange K. Implementation Timing 1. Implementation Date 2. Special Considerations at Implementation a. Pending Applications and Implementation of the Community Engagement Requirement b. Community Engagement Requirement for Enrolled Beneficiaries at Implementation 3. Systems Changes Needed To Implement Community Engagement 4. Good Faith Effort Exemption a. Process and Timing of Requests b. Criteria for Good Faith Effort Determination c. Duration of Exemption d. Reporting Requirements for States Granted Good Faith Effort Exemptions L. Outreach M. Managed Care Implications N. Additional Considerations 1. Implications of Community Engagement on Presumptive Eligibility and Presumptive Eligibility Determined by Hospitals 2. Additional Considerations for Section 1115 Demonstrations O. Monitoring III. Good Cause for Proceeding With an Interim Final Rule With Comment Period IV. Collection of Information Requirements A. Wage Estimates 1. States and the Private Sector 2. Beneficiaries B. Adjustment to State Cost Estimates C. Information Collection Requirements (ICRs) 1. ICRs Regarding State Requirements To Submit Data for Monitoring Community Engagement (§ 435.562) a. Performance Indicator Data (Annual Reporting for Monitoring Community Engagement) b. Eligibility Processing Data (Annual Reporting for Monitoring Community Engagement) c. T-MSIS Data 2. ICRs Regarding Good Faith Effort Exemptions and Quarterly Reporting (§ 435.560) 3. ICRs Regarding State Plan Amendment (SPA) Submissions To Implement and Confirm Compliance (§ 430.10) 4. ICRs Regarding Verification Plan Submission and Updates (§ 435.557) 5. ICRs Regarding Beneficiary Application Updates (Single Streamlined and Presumptive Eligibility Applications) (§§ 435.912, 435.556, and 435.557) 6. ICRs Regarding Short-Term Hardship Exception Requests (§ 435.555) 7. ICRs Regarding State Requirements for Outreach (§ 435.561) and Noncompliance (§ 435.558). D. Burden Summary E. Submission of PRA-Related Comments V. Regulatory Impact Analysis A. Statement of Need B. Overall Impact C. Detailed Economic Analysis 1. Benefits a. Medicaid Applicants and Beneficiaries Subject to the Community Engagement Requirement 2. Costs a. State and Federal Costs b. Costs to Medicaid Beneficiaries 3. Transfers a. Impacts on Medicaid Enrollment and Benefit Expenditures 4. Aggregate Time Allocation and Additional Effects on the Federal Deficit 5. Regulatory Review Cost Estimation D. Alternatives Considered 1. Compliance and Verification Provisions 2. State Implementation 3. Monitoring and Reporting E. Accounting Statement F. Regulatory Flexibility Act (RFA) G. Unfunded Mandates Reform Act (UMRA) H. Federalism I. E.O. 14192 , “Unleashing Prosperity Through Deregulation” J. Conclusion List of Subjects 42 CFR Part 431 42 CFR Part 435 42 CFR Part 438 42 CFR Part 457 42 CFR Part 600 PART 431—STATE ORGANIZATION AND GENERAL ADMINISTRATION PART 435—ELIGIBILITY IN THE STATES, DISTRICT OF COLUMBIA, THE NORTHERN MARIANA ISLANDS, AND AMERICAN SAMOA Community Engagement Requirement Community Engagement Requirement PART 438—MANAGED CARE PART 457—ALLOTMENTS AND GRANTS TO STATES PART 600—ADMINISTRATION, ELIGIBILITY, ESSENTIAL HEALTH BENEFITS, PERFORMANCE STANDARDS, SERVICE DELIVERY REQUIREMENTS, PREMIUM AND COST SHARING, ALLOTMENTS, AND RECONCILIATION Footnotes Enhanced Content - Table of Contents

Related Documents Enhanced Content - Related Documents FederalRegister.gov uses the agency dockets published with the document to display related documents. CMS-2454-IFC ( 2 Documents ) Date Action Title 06/29/2026 Medicaid Program; Community Engagement Requirement for Certain Individuals 06/03/2026 Interim final rule with comment period. Medicaid Program; Community Engagement Requirement for Certain Individuals Enhanced Content - Related Documents

Public Comments Enhanced Content - Public Comments Comments are being accepted - Submit a public comment . 4,380 comments have been received at Regulations.gov. Agencies review all submissions and may choose to redact, or withhold, certain submissions (or portions thereof). Submitted comments may not be available to be read until the agency has approved them. Docket Title Document ID Comments Community Engagement Requirement for Certain Individuals. CMS-2454-IFC CMS-2026-2047-0002 4,380 Enhanced Content - Public Comments

Regulations.gov Data Enhanced Content - Regulations.gov Data FederalRegister.gov retrieves relevant information about this document from Regulations.gov to provide users with additional context. This information is not part of the official Federal Register document. Community Engagement Requirement for Certain Individuals. CMS-2454-IFC Comment Due Date 07/31/2026 Docket ID CMS-2026-2047 Supporting Documents No supporting documents available Enhanced Content - Regulations.gov Data

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