6. Verifying Compliance With Community Engagement Activities

As implemented at § 435.552 and discussed in detail in section II.C. of this IFC, applicable individuals subject to the community engagement requirement can meet the requirement ( printed page 33398) through engaging in a minimum of 80 hours per month of work, community service, or participation in a work program; being enrolled in an educational program at least half-time; or a combination thereof. Individuals also can demonstrate community engagement by having a monthly income that is not less than the applicable Federal minimum wage multiplied by 80 hours. Seasonal workers may demonstrate community engagement by having an average monthly income over the preceding 6 months that is not less than the applicable Federal minimum wage multiplied by 80 hours.

Section 1902(xx)(1)(A) of the Act and implementing regulations at § 435.556 provide that States must require applicable individuals who are applying for Medicaid to demonstrate that they meet the community engagement requirement for the 1 month (or, at State option, the 2 or 3 consecutive months) preceding the month of application. Section 1902(xx)(1)(B)(i) of the Act provides that States must require applicable individuals who are enrolled beneficiaries to demonstrate that they meet the community engagement requirement for 1 or, at State option, more months between the individual's most recent eligibility determination and their next renewal. Where demonstrating community engagement for more than 1 month is required, the State may not require that the months be consecutive under section 1902(xx)(1)(B) of the Act (for example, a State that requires 2 months may not require that those 2 months be consecutive). See section II.H. of this IFC for more information about assessing compliance.

Section 1902(xx)(4) of the Act provides States with the option to verify compliance with the community engagement requirement between an applicable individual's regular renewals. States that elect this option have the option to determine the frequency with which to verify compliance. In States that elect to conduct more frequent verification of compliance with the community engagement requirement, under section 1902(xx)(1)(B)(ii) of the Act, the State must verify that applicable individuals met the community engagement requirement for 1 or more months (at State option), whether or not consecutive, between the most recent verification of compliance and the current verification. As described in section II.H.1. of this IFC, prior to verifying compliance with the community engagement requirement, the State must first confirm the individual is an applicable individual subject to the community engagement requirement and not a specified excluded individual.

We remind States that effective January 1, 2027, most of the population required to demonstrate community engagement is also subject to a new 6-month renewal requirement for the adult group under section 1902(e)(14)(L) of the Act. The 6-month renewal requirement does not apply to American Indians or to individuals enrolled in section 1115 demonstrations (except for those that cover certain adults eligible under a section 1115 demonstration that provides MEC to all individuals who would be eligible if the State provided coverage to the adult group under the State plan); for these individuals, eligibility must be renewed every 12 months. States are advised to consider the more frequent renewal requirement when determining whether to verify community engagement compliance between renewals (in general, that is, more frequently than every 6 months) and when determining the number of months for which an applicable individual must demonstrate compliance between verifications. Specifically, if electing more frequent verification, States may wish to consider the timing of the renewal process, particularly how far in advance the State initiates the renewals in relation to the end of the eligibility period, and the State's ability to access timely data to verify compliance and otherwise renew eligibility when determining the verification frequency and number of months.

Later in this section, we discuss verification requirements and options for verifying that an individual has demonstrated or is deemed as having demonstrated community engagement for the required month(s) at application, renewal, or between renewals (if applicable). As noted in section II.I.1. of this IFC, under section 1902(xx)(5) of the Act and § 435.557(b), States must first attempt to verify that applicable individuals who are applicants or beneficiaries have met the community engagement requirement using reliable information available to the State before requesting additional information from the individual, in accordance with requirements at § 435.557(b)(2), or initiating noncompliance procedures as discussed in section II.J.2. of this IFC and implemented at § 435.558. States may request documentation or additional information only if there is no reliable information available to the State to verify compliance or the reliable information is not reasonably compatible with information provided by or on behalf of the individual.