In January 2018, the Centers for Medicare & Medicaid Services (CMS) issued guidance setting forth the standards it will apply in granting state waivers conditioning Medicaid eligibility on compliance with work and community engagement requirements. Thereafter, it approved section 1115 waivers for Kentucky, Indiana, New Hampshire and Arkansas that included such requirements, along with other changes to those states’ Medicaid programs. More waiver approvals will follow. This is the first time work requirements have been allowed in the Medicaid program, and at least 12 states have submitted work requirement waivers; others are considering doing so in the near future. To date, CMS has only approved work/community engagement requirements in states that have expanded their Medicaid programs to all adults with incomes below 138 percent of the federal poverty level. A handful of non-expansion states have work requirement waiver requests pending with CMS.

Whether a state chooses to implement a work/community engagement program, and how it constructs that program, is of importance to hospitals and health systems. Eligibility conditions and enrollment complexities that affect access to continuous coverage could result in uncompensated care and challenge hospitals’ ability to manage patient care.

Originally published in American Hospital Association on May 29, 2018.