Overview
- CMS issued detailed guidance on the medically frail exemption on Monday that narrows who automatically qualifies and sets the framework for states to implement federal work requirements starting January 1, 2027.
- The rule says a diagnosis alone may not qualify someone as medically frail and requires states to show a condition significantly limits a person’s ability to meet an 80-hour per month engagement requirement.
- Self-attestation is allowed through 2027 but will be tightened in 2028 so beneficiaries must provide documentation at renewal after a one-time attestation, increasing verification steps for patients and clinicians.
- States that already spent millions building eligibility systems must reconfigure IT and hire staff to comply, and advocates warn the added paperwork will cause administrative disenrollments with the CBO projecting about 7.5 million fewer enrollees by 2034.
- Patient groups are preparing formal comments and likely legal challenges while policy experts urge states to hire navigators and expand outreach to help vulnerable people meet reporting rules and stay enrolled.