3. Assessing Compliance for Enrolled Beneficiaries

At new § 435.556(a)(2), we implement the requirement under section 1902(xx)(1)(B) of the Act that the State must require an applicable individual who is enrolled and receiving medical assistance to demonstrate community engagement as a condition of eligibility.

Section 1902(xx)(1)(B) of the Act specifies that States must require an applicable individual who is enrolled and receiving medical assistance to demonstrate community engagement “for 1 or more months, as specified by the State, whether or not consecutive” at renewal or, at State option, more frequently. We interpret this to mean that a State must specify the number of months for which the enrolled applicable individual must demonstrate community engagement either between renewals or, if elected by the State, between more frequent verifications of community engagement. The State must specify a minimum of 1 month and may elect to require that individuals demonstrate more than 1 month of compliance with the community engagement requirement during the review period. The State must consider a beneficiary who is an applicable individual to have successfully met the requirement if during any part of the review period under consideration (either between renewals or between more frequent verifications, if elected by the State), the beneficiary demonstrates or is deemed to demonstrate community engagement for the number of months specified by the State. The statute does not specify the maximum length of the review period. To ensure that a State does not require an individual to demonstrate community engagement outside of the review period, at § 435.556(b), we prohibit States from requiring an applicable individual to demonstrate community engagement for a number of months that exceeds the applicable review period.

Section 1902(xx)(a)(1)(B) of the Act provides that, at renewal or at more frequent verification, if elected by the State, an applicable individual must demonstrate community engagement for 1 or more months “whether or not consecutive.” Although the statute leaves to the State's discretion the number of months for which a beneficiary who is an applicable individual must demonstrate community engagement, the clause, “whether or not consecutive” is not modified by a grant of discretion to the State. We therefore interpret it not to permit the State to require a beneficiary to demonstrate community engagement for consecutive months, if the State elects to require more than 1 month, or to dictate the specific month(s) for which an applicable individual must demonstrate community engagement during the review period between renewals or more frequent verifications, if elected by the State.

We will discuss next how the review period is defined for beneficiaries and how States must assess compliance at renewal or at more frequent verifications. We also address requirements for States that elect to conduct more frequent verifications of community engagement, beyond the minimum required verification as part of a beneficiary's regular renewal.