6. Individuals Compliant With TANF Work Requirements and Individuals Not Exempt From SNAP Work Requirements

Section 1902(xx)(9)(A)(ii)(VI) of the Act creates an exclusion that references existing work requirements in other jointly administered Federal-State programs. Specifically, clause (ii)(VI)(aa) references the TANF block grants, and clause (ii)(VI)(bb) references SNAP. While the TANF [ 76 ] and SNAP [ 77 ] statutes both use the terminology “work requirements,” the term is inclusive of work and activities other than work, such as education, job training, community service, volunteering, etc.

Section 1902(xx)(9)(A)(ii)(VI)(aa) of the Act excludes individuals who are “in compliance with any requirements imposed by the State under section 407 of the Act” from having to meet the Medicaid community engagement requirement. Section 407 of the Act establishes mandatory work requirements and performance standards for the TANF program. Unlike other work requirements that apply to individuals, these Federal requirements establish performance standards that States must achieve; States have flexibility in how they implement work requirements placed on individuals to meet the performance standards outlined in section 407 of the Act. [ 78 ] We adopt the language of section 1902(xx)(9)(A)(ii)(VI)(aa) of the Act in new regulation at § 435.554(c)(6). Because States may define compliance with TANF work requirements differently, we are not prescribing a uniform definition of compliance with TANF work requirements for the purposes of this exclusion. Instead, when determining whether an individual is eligible for the TANF exclusion from the Medicaid community engagement requirement, the State Medicaid agency should assess whether the individual is compliant with the specific TANF work requirements established by the State. Consistent with section II.I.7.f. of this IFC, State Medicaid agencies should work closely with the State agency that administers TANF to determine which individuals are eligible for this TANF-based exclusion. To implement this exclusion, States should not rely on or require reporting from the individual. We also note that most potentially applicable individuals who receive TANF will fall under other exclusions, such as those for parent, guardian, or caretaker relative of a child age 13 or younger, described at 435.554(c)(3).

Section 1902(xx)(9)(A)(ii)(VI)(bb) of the Act, implemented at new § 435.554(c)(7), creates an exclusion for an individual who “is a member of a household that receives [SNAP] benefits . . . and is not exempt from a work requirement under the Food and Nutrition Act of 2008.” Based on the plain language of the statute, we interpret the use of “not exempt from” in this provision to mean “subject to” a work requirement under the Food and Nutrition Act of 2008. If an individual is in a household that receives SNAP benefits and is subject to a work requirement under the SNAP program, they meet the definition of a specified excluded individual and are therefore not an applicable individual subject to the Medicaid community engagement requirement.

Unlike the TANF exclusion from community engagement, which requires the State to ensure the individual is compliant with TANF work requirements to meet the definition for the exclusion, for the SNAP exclusion, States only need to determine that the individual is not exempt from SNAP work requirements and is in a household that receives SNAP benefits; the State does not need to confirm that the individual is in fact compliant with SNAP work requirements. CMS is aware that SNAP has two types of work requirements: general work requirements, defined in section (6)(d)(1) of the Food and Nutrition Act of 2008, and the time limit work requirement, defined in section (6)(o) of such Act. Because section 1902(xx) of the Act does not specify which SNAP work requirements apply to this exclusion, we interpret the statute to mean that both requirements apply. Therefore, an individual would be considered a specified excluded individual if they were a member of a household receiving SNAP benefits, and were not exempt from the general work requirement, time limit work requirement, or both—meaning they were subject to at least one of the SNAP work requirements. Consistent with section II.I.7.f. of this IFC, State Medicaid agencies should work closely with the State agency that administers SNAP to determine which individuals are eligible for this exclusion.

Both TANF and SNAP have long-standing work requirements for adults, with some exceptions, as a condition of ( printed page 33378) receiving benefits. Using national data from 2019, the Office of the Assistant Secretary for Planning and Evaluation in HHS, estimated that approximately 40 percent of Medicaid beneficiaries nationally were also enrolled in SNAP, and 4 percent were also enrolled in TANF. [ 79 ] This exclusion ensures that Medicaid beneficiaries do not need to also meet the Medicaid community engagement requirement if they are already subject to SNAP and/or meeting TANF requirements. Because of the population overlap between these programs, this exclusion can reduce the burden on beneficiaries who may be eligible for and receiving benefits from multiple programs and allows States to use information regarding an individual from these programs to verify their exclusion or need to demonstrate Medicaid community engagement.