PRESS RELEASE
FOR IMMEDIATE RELEASE
Jan 11, 2018
Contact: CMS Media Relations
(202) 690-6145 | CMS
Media Inquiries
CMS announces new policy guidance for states to
test
community engagement for able-bodied adults
Will support states helping Medicaid
beneficiaries improve well-being and achieve self-sufficiency
CMS today announced new guidance that will
support state efforts to improve Medicaid enrollee health outcomes by
incentivizing community engagement among able-bodied, working-age
Medicaid beneficiaries. The policy responds to numerous state requests to
test programs through Medicaid demonstration projects under which work or
participation in other community engagement activities – including skills
training, education, job search, volunteering or caregiving – would be a
condition for Medicaid eligibility for able-bodied, working-age adults.
This would exclude individuals eligible for Medicaid due to a disability,
elderly beneficiaries, children, and pregnant women.
The new policy guidance sent to states is intended to help them design
demonstration projects that promote the objectives of the Medicaid program
and are consistent with federal statutory requirements. To achieve the
objectives of Medicaid, state programs should be designed to promote better
physical and mental health.
“Medicaid needs to be more flexible so that states can best address the
needs of this population. Our fundamental goal is to make a positive and
lasting difference in the health and wellness of our
beneficiaries, and today’s announcement is a step in that direction,” said
Seema Verma, CMS Administrator.
To date, CMS has received demonstration project proposals from 10 states
that include employment and community engagement initiatives: Arizona,
Arkansas, Indiana, Kansas, Kentucky, Maine, New Hampshire, North Carolina,
Utah and Wisconsin.
“Our policy guidance was in response to states that asked us for the
flexibility they need to improve their programs and to help people in
achieving greater well-being and self-sufficiency,” said Verma.
Announcement of the new guidance delivers on the commitment made by Administrator
Verma in her address
to state Medicaid directors last November, to “turn the page” in the
Medicaid program and give states more freedom to design innovative programs
that achieve positive results for the people they serve and to remove
bureaucratic barriers that block states from achieving this goal.
Criteria and
Parameters of the New Policy Guidance
CMS has identified a number of issues for states to consider in the
development of proposals to promote work and other community engagement
among working-age, non-pregnant Medicaid beneficiaries not eligible for
Medicaid on the basis of a disability.
Meeting work and community engagement requirements should take into
consideration areas of high unemployment or caregiving for young children
or elderly family members. States will therefore be required to describe
strategies to assist eligible individuals in meeting work and community
engagement requirements and to link individuals to additional resources for
job training, provided they do not use federal Medicaid funding to finance
these services.
CMS will support state efforts to align Medicaid work and community
engagement requirements with SNAP or TANF requirements, where appropriate,
as part of this demonstration opportunity. Aligning requirements across
these programs may streamline eligibility and reduce the burden on both
states and beneficiaries and help beneficiaries succeed in meeting their
work and community engagement responsibilities.
States must also fully comply with federal disability and civil rights
laws and ensure that all individuals with disabilities have the necessary
protections to ensure that they are not inappropriately denied coverage.
States will be required to offer reasonable modifications to individuals
with disabilities, and will be required to exempt individuals determined to
be medically frail or who have an acute condition that a medical
professional has determined will prevent them from complying with the
requirements.
Administrator Verma cited the Administration’s firm commitment to combat
our nation's opioid crisis and the letter outlines that CMS will require states to make reasonable
modifications for individuals with opioid addiction and other substance use
disorders. These modifications may include counting time spent in medical
treatment toward an individual’s community engagement requirements or
exempting individuals participating in intensive inpatient or outpatient
medical treatment, as well as supporting other state efforts.
CMS also encourages states to consider a range of activities that could
satisfy work and community engagement requirements. States should ensure
that career planning, job training, referral, and volunteering
opportunities considered to meet the community engagement requirement, and
job support services offered in connection with the requirement, take into
account people’s employability and potential contributions to the labor
market.
“States have the opportunity to help individuals improve and enhance the
skills that employers truly value,” said Verma. “People who participate in
activities that increase their education and training are more likely to
find sustainable employment, have higher earnings, a better quality of
life, and, studies have shown, improved health outcomes.”
Medicaid Demonstration Projects
Section 1115 of the Social Security Act gives the Secretary of Health
and Human Services authority to approve experimental, pilot, or
demonstration projects determined by the Secretary to be likely to assist
in promoting the objectives of the Medicaid program. Demonstrations, which
give states additional flexibility to design and improve their programs,
are also designed to evaluate state-specific policy approaches and better
serve Medicaid populations.
Administrator Verma also announced that CMS has updated Medicaid.gov to
give states a clearer indication of how their reform strategies under
section 1115 should align with a core objective of the Medicaid program:
serving the health and wellness needs of the nation’s vulnerable and
low-income individuals and families. The revised website content signals a
new, broader view of these demonstrations in which states can focus on
evidence-based approaches that drive better health outcomes, and quality of
life improvements, and support upward mobility and self-sufficiency.
On March 14, 2017, the Department of Health and Human Services and CMS
issued a letter to the nation’s governors affirming the federal
government’s partnership with states to improve the integrity and
effectiveness of the Medicaid program for low-income people with Medicaid.
The letter encourages states to bring forward proposals grounded in ideas
that reflect the dynamics and culture of a state.
“This new guidance paves the way for states to demonstrate how their
ideas will improve the health of Medicaid beneficiaries, as well as
potentially improve their economic well-being,” said Brian Neale, CMS
Deputy Administrator and Director for the Center for Medicaid and CHIP
Services.
To view a copy of the SMD letter # 18-002, please click here.
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