Procedure in the case of noncompliance.—

Official source

“(6) Procedure in the case of noncompliance.— “(A) Notices. In general.— If a State is unable to verify that an applicable individual has met the requirement to demonstrate community engagement under paragraph (1) (including, if applicable, by verifying that such individual was deemed to have demonstrated community engagement under paragraph (3)) the State shall (in accordance with standards specified by the Secretary)— “(i) provide such individual with the notice of noncompliance described in subparagraph (B); “(ii) (I) provide such individual with a period of 30 calendar days, beginning on the date on which such notice of noncompliance is received by the individual, to— “(aa) make a satisfactory showing to the State of compliance with such requirement (including, if applicable, by showing that such individual was or should be deemed to have demonstrated community engagement under paragraph (3)); or “(bb) make a satisfactory showing to the State that such requirement does not apply to such individual on the basis that such individual does not meet the definition of applicable individual under paragraph (9)(A); and 139 STAT. 310 “(II) if such individual is enrolled under the State plan (or a waiver of such plan) under this title, continue to provide such individual with medical assistance during such 30-calendar-day period; and “(iii) Deadline. Determination. if no such satisfactory showing is made and the individual is not a specified excluded individual described in paragraph (9)(A)(ii), deny such individual’s application for medical assistance under the State plan (or waiver of such plan) or, as applicable, disenroll such individual from the plan (or waiver of such plan) not later than the end of the month following the month in which such 30-calendar-day period ends, provided that— “(I) the State first determines whether, with respect to the individual, there is any other basis for eligibility for medical assistance under the State plan (or waiver of such plan) or for another insurance affordability program; and “(II) the individual is provided written notice and granted an opportunity for a fair hearing in accordance with subsection (a)(3). “(B) Notice.— The notice of noncompliance provided to an applicable individual under subparagraph (A)(i) shall include information (in accordance with standards specified by the Secretary) on— “(i) how such individual may make a satisfactory showing of compliance with such requirement (as described in subparagraph (A)(ii)) or make a satisfactory showing that such requirement does not apply to such individual on the basis that such individual does not meet the definition of applicable individual under paragraph (9)(A); and “(ii) how such individual may reapply for medical assistance under the State plan (or a waiver of such plan) under this title in the case that such individuals’ application is denied or, as applicable, in the case that such individual is disenrolled from the plan (or waiver).

Procedure in the case of noncompliance.—

Official source

- name: monthly_activity_hours_requirement kind: parameter dtype: Decimal source: 42 USC 1396a(xx)(2)(A)-(E) metadata: proof: atoms: - path: versions[0].formula kind: amount source: corpus_citation_path: us/statute/42/1396a/xx excerpt: not less than 80 hours versions: - effective_from: '2026-12-31' formula: '80'

- name: seasonal_worker_income_lookback_months kind: parameter dtype: Count source: 42 USC 1396a(xx)(2)(G) metadata: proof: atoms: - path: versions[0].formula kind: amount source: corpus_citation_path: us/statute/42/1396a/xx excerpt: average monthly income over the preceding 6 months versions: - effective_from: '2026-12-31' formula: '6'

- name: hardship_unemployment_rate_threshold kind: parameter dtype: Rate source: 42 USC 1396a(xx)(3)(B)(ii)(II)(bb)(AA) metadata: proof: atoms: - path: versions[0].formula kind: amount source: corpus_citation_path: us/statute/42/1396a/xx excerpt: 8 percent versions: - effective_from: '2026-12-31' formula: '0.08'

- name: hardship_national_unemployment_rate_multiplier kind: parameter dtype: Decimal source: 42 USC 1396a(xx)(3)(B)(ii)(II)(bb)(BB) metadata: proof: atoms: - path: versions[0].formula kind: amount source: corpus_citation_path: us/statute/42/1396a/xx excerpt: 1.5 times the national unemployment rate versions: - effective_from: '2026-12-31' formula: '1.5'

- name: community_engagement_met_by_activity_or_income kind: derived entity: Person dtype: Judgment period: Month source: 42 USC 1396a(xx)(2) metadata: proof: atoms: - path: versions[0].formula kind: formula source: corpus_citation_path: us/statute/42/1396a/xx excerpt: meets 1 or more of the following conditions versions: - effective_from: '2026-12-31' formula: >- monthly_work_hours >= monthly_activity_hours_requirement or monthly_community_service_hours >= monthly_activity_hours_requirement or monthly_work_program_hours >= monthly_activity_hours_requirement or enrolled_in_educational_program_at_least_half_time or monthly_combined_engagement_activity_hours >= monthly_activity_hours_requirement or monthly_income >= applicable_minimum_wage_hourly_rate * monthly_activity_hours_requirement or (seasonal_worker and average_monthly_income_over_preceding_6_months >= applicable_minimum_wage_hourly_rate * monthly_activity_hours_requirement)

- name: educational_program kind: derived entity: Person dtype: Judgment period: Month source: 42 USC 1396a(xx)(9)(B) metadata: proof: atoms: - path: versions[0].formula kind: definition source: corpus_citation_path: us/statute/42/1396a/xx - path: versions[0].formula kind: import import: target: us:statutes/26/3304#institution_of_higher_education output: institution_of_higher_education hash: sha256:86fc1e04b86968a3fea7737fce53a8297bc20be9c7896e4527512caed95bff86 versions: - effective_from: '2026-12-31' formula: |- institution_of_higher_education or enrolled_in_career_and_technical_education_program

- name: mandatory_community_engagement_deeming_applies kind: derived entity: Person dtype: Judgment period: Month source: 42 USC 1396a(xx)(3)(A) metadata: proof: atoms: - path: versions[0].formula kind: exception source: corpus_citation_path: us/statute/42/1396a/xx versions: - effective_from: '2026-12-31' formula: |- was_specified_excluded_individual_for_part_or_all_of_month or was_under_age_19_for_part_or_all_of_month or was_entitled_to_or_enrolled_for_medicare_part_a_or_b_for_part_or_all_of_month or was_described_in_subsection_a_10_A_i_I_through_VII_for_part_or_all_of_month or was_inmate_of_public_institution_during_3_month_period_ending_first_day_of_month

- name: short_term_hardship_event kind: derived entity: Person dtype: Judgment period: Month source: 42 USC 1396a(xx)(3)(B)(ii) metadata: proof: atoms: - path: versions[0].formula kind: definition source: corpus_citation_path: us/statute/42/1396a/xx versions: - effective_from: '2026-12-31' formula: >- received_high_acuity_services_for_part_or_all_of_month or county_has_presidential_emergency_or_disaster_for_part_or_all_of_month or county_unemployment_rate >= min(hardship_unemployment_rate_threshold, hardship_national_unemployment_rate_multiplier * national_unemployment_rate) or individual_or_dependent_must_travel_outside_community_for_extended_medically_necessary_services

- name: optional_hardship_deeming_applies kind: derived entity: Person dtype: Judgment period: Month source: 42 USC 1396a(xx)(3)(B)(i) metadata: proof: atoms: - path: versions[0].formula kind: exception source: corpus_citation_path: us/statute/42/1396a/xx versions: - effective_from: '2026-12-31' formula: >- state_plan_provides_optional_short_term_hardship_deeming and short_term_hardship_event and (county_has_presidential_emergency_or_disaster_for_part_or_all_of_month or county_unemployment_rate >= min(hardship_unemployment_rate_threshold, hardship_national_unemployment_rate_multiplier * national_unemployment_rate) or individual_requested_hardship_deeming)

- name: deemed_to_have_demonstrated_community_engagement kind: derived entity: Person dtype: Judgment period: Month source: 42 USC 1396a(xx)(3) metadata: proof: atoms: - path: versions[0].formula kind: formula source: corpus_citation_path: us/statute/42/1396a/xx versions: - effective_from: '2026-12-31' formula: |- mandatory_community_engagement_deeming_applies or optional_hardship_deeming_applies

- name: state_may_waive_verification_for_deemed_community_engagement kind: derived entity: Person dtype: Judgment period: Month source: 42 USC 1396a(xx)(3)(C) metadata: proof: atoms: - path: versions[0].formula kind: condition source: corpus_citation_path: us/statute/42/1396a/xx excerpt: may elect to not require an individual to verify information resulting in such deeming versions: - effective_from: '2026-12-31' formula: |- state_elects_not_to_require_verification_for_deemed_community_engagement and deemed_to_have_demonstrated_community_engagement

- name: demonstrated_community_engagement_for_month kind: derived entity: Person dtype: Judgment period: Month source: 42 USC 1396a(xx)(2)-(3) metadata: proof: atoms: - path: versions[0].formula kind: formula source: corpus_citation_path: us/statute/42/1396a/xx versions: - effective_from: '2026-12-31' formula: |- community_engagement_met_by_activity_or_income or deemed_to_have_demonstrated_community_engagement

- name: specified_excluded_individual kind: derived entity: Person dtype: Judgment period: Month source: 42 USC 1396a(xx)(9)(A)(ii) metadata: proof: atoms: - path: versions[0].formula kind: definition source: corpus_citation_path: us/statute/42/1396a/xx versions: - effective_from: '2026-12-31' formula: >- described_in_subsection_a_10_A_i_IX or is_indian_urban_indian_california_indian_or_ihs_eligible_indian or is_parent_guardian_caretaker_relative_or_family_caregiver_of_dependent_child_age_13_or_under_or_disabled_individual or is_veteran_with_total_disability_rating or is_medically_frail_or_has_special_medical_needs or complies_with_tanf_work_requirements_or_is_nonexempt_snap_work_requirement_household_member or participates_in_drug_addiction_or_alcoholic_treatment_and_rehabilitation_program or is_inmate_of_public_institution or is_pregnant_or_entitled_to_postpartum_medical_assistance

- name: applicable_individual kind: derived entity: Person dtype: Judgment period: Month source: 42 USC 1396a(xx)(9)(A)(i) metadata: proof: atoms: - path: versions[0].formula kind: definition source: corpus_citation_path: us/statute/42/1396a/xx versions: - effective_from: '2026-12-31' formula: >- not specified_excluded_individual and (eligible_or_enrolled_under_subsection_a_10_A_i_VIII or (eligible_or_enrolled_under_equivalent_minimum_essential_coverage_waiver and has_attained_age_19_and_is_under_age_65 and not pregnant and not entitled_to_or_enrolled_for_medicare_part_a_or_b and not otherwise_eligible_to_enroll_under_state_plan))