WASHINGTON, D.C. — The Centers for Medicare & Medicaid Services has issued an interim final rule establishing a nationwide framework requiring certain adult Medicaid recipients to complete at least 80 hours per month of work, education, job training, or community service to maintain eligibility, a policy change that states must implement by Jan. 1, 2027.
The rule implements provisions of Public Law 119-21, which CMS refers to as the Working Families Tax Cut legislation, and establishes federal standards for eligibility determinations, exemptions, compliance verification, reporting requirements, and beneficiary communications.
The policy applies to certain Medicaid beneficiaries ages 19 to 64. CMS said numerous categories of individuals will be exempt, including pregnant and postpartum women, people with disabilities, medically frail individuals, American Indians and Alaska Natives, caregivers of young children or people with disabilities, and beneficiaries already meeting similar requirements through SNAP or Temporary Assistance for Needy Families programs.
CMS Administrator Dr. Mehmet Oz said the rule is intended to connect Medicaid eligibility with employment and workforce participation.
“This rule helps Americans build skills and independence through work, education, job training, or community service, creating new opportunities for themselves and their families,” Oz said.
The agency cited a study from the Department of Health and Human Services’ Office of the Assistant Secretary for Planning and Evaluation that found the new requirements could reduce poverty by as many as 2.9 million people, depending on labor market conditions and other factors.
The regulation also establishes state reporting requirements and outlines how states must verify compliance and notify beneficiaries of the new standards. CMS said the framework is designed to standardize implementation while reducing administrative burdens on state agencies.
To support implementation, CMS said the legislation authorizes $200 million in Government Efficiency Grants to help states modernize eligibility systems and administrative operations. The agency also reported more than $600 million in pledged support from private-sector technology vendors to assist with system upgrades, enrollment processes, data integration, and beneficiary outreach.
Some states have already begun implementing work requirements. CMS identified Nebraska as one state that has moved ahead of the federal deadline, while other states are considering early adoption.
The agency issued the rule with an accompanying public comment period while implementation proceeds. CMS said the approach is intended to meet the statutory timeline while allowing additional stakeholder feedback before the policy is finalized.
The interim final rule is available through the Federal Register at https://www.federalregister.gov.
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