Requirement for States to Establish Medicaid Community Engagement Requirements for Certain Individuals
Section 71119 · Sec. 71119 ·
What this chapter is about
This part makes some adults show 80 hours a month of work or study to keep Medicaid. It starts with the first quarter after 2026. Several groups are exempt, including under 19s and pregnant women. Anyone found short gets notice and 30 days to answer.
“a State shall provide, as a condition of eligibility for medical assistance for an applicable individual, that such individual is required to demonstrate community engagement under paragraph (2)--”
The section adds a new subsection (xx) to section 1902 of the Social Security Act (42 U.S.C. 1396a) requiring a State, no later than the first day of the first quarter beginning after December 31, 2026 or an earlier date the State chooses, to make demonstrating community engagement a condition of eligibility. An applicant must show it for one to three consecutive months right before the month of application, as the State specifies, and an enrollee for one or more months, whether or not consecutive, between determinations or between verifications.
What the document actually says
“a State shall provide, as a condition of eligibility for medical assistance for an applicable individual, that such individual is required to demonstrate community engagement under paragraph (2)--”
That sentence, in plain words
The state must make this a rule for getting Medicaid. The person must show they took part in work or study.
What this is about
It starts with the first quarter after 2026. A state may start sooner. An applicant must show it for up to three months before applying.
No action is recorded against this proposal. That is not evidence that none has been taken, and nobody has yet read it against the record. See what the tracker does not yet cover.
The document says “means”Who acts: Secretary of Health and Human ServicesHow: statuteSec. 71119 in the PDF
What the document says
“The individual works not less than 80 hours.”
The section lets a person show community engagement for a month by working at least 80 hours, doing at least 80 hours of community service, taking part in a work program for at least 80 hours, enrolling at least half-time in an educational program, combining those activities for at least 80 hours, having monthly income at least the applicable minimum wage times 80 hours, or being a seasonal worker with average monthly income over the last six months at that level.
What the document actually says
“The individual works not less than 80 hours.”
That sentence, in plain words
The person works at least 80 hours in the month.
What this is about
Community service counts the same way. So does a work program or half-time study. Income at minimum wage times 80 hours also counts.
No action is recorded against this proposal. That is not evidence that none has been taken, and nobody has yet read it against the record. See what the tracker does not yet cover.
“The State shall deem an applicable individual to have demonstrated community engagement under paragraph (2) for a month, and may elect to not require an individual to verify information resulting in such deeming, if--”
The section requires the State to treat a person as having met the rule for a month where, for part or all of that month, the person was a specified excluded individual, was under 19, was entitled to or enrolled for Medicare part A or enrolled for part B, or fell within named subclauses of section 1902(a)(10)(A)(i), and where a short-term hardship event applied during a three month window. The State may choose not to make the person verify the facts behind the deeming.
What the document actually says
“The State shall deem an applicable individual to have demonstrated community engagement under paragraph (2) for a month, and may elect to not require an individual to verify information resulting in such deeming, if--”
That sentence, in plain words
The state must treat the person as having met the rule. It may also skip asking them to prove it.
What this is about
Several groups are covered. Under 19s are one. People on Medicare are another. A short-term hardship also counts.
No action is recorded against this proposal. That is not evidence that none has been taken, and nobody has yet read it against the record. See what the tracker does not yet cover.
“the State shall verify (in accordance with procedures specified by the Secretary) that each such individual has met the requirement to demonstrate community engagement under paragraph (1) during each such individual's regularly scheduled redetermination of eligibility, except that a State may provide for such verifications more frequently.”
The section requires the State to check, under procedures the Secretary specifies, that each enrolled applicable individual has met the requirement at each regularly scheduled redetermination, and lets the State check more often.
What the document actually says
“the State shall verify (in accordance with procedures specified by the Secretary) that each such individual has met the requirement to demonstrate community engagement under paragraph (1) during each such individual's regularly scheduled redetermination of eligibility, except that a State may provide for such verifications more frequently.”
That sentence, in plain words
The state must check that the person met the rule. That happens at each regular review. A state may check more often if it wants.
What this is about
The Secretary sets how the check is done. The regular review is the base point. More checks are a state choice.
No action is recorded against this proposal. That is not evidence that none has been taken, and nobody has yet read it against the record. See what the tracker does not yet cover.
“the State shall, in accordance with standards established by the Secretary, establish processes and use reliable information available to the State”
The section requires the State, under standards the Secretary sets, to build processes and use reliable information it already has, such as payroll data or payment and encounter data under the program, so that where possible the individual need not send in more information, whether it is checking compliance, deeming, or whether someone is a specified excluded individual.
What the document actually says
“the State shall, in accordance with standards established by the Secretary, establish processes and use reliable information available to the State”
That sentence, in plain words
The state must set up a process. It must use reliable data it already holds. The Secretary sets the standards.
What this is about
Payroll data is one such source. Claims data is another. Where that works the person is not asked for more.
No action is recorded against this proposal. That is not evidence that none has been taken, and nobody has yet read it against the record. See what the tracker does not yet cover.
“If a State is unable to verify that an applicable individual has met the requirement to demonstrate community engagement under paragraph (1)”
The section requires the State, under standards the Secretary specifies, where it cannot verify that an applicable individual met the requirement, to give the person a notice of noncompliance and 30 calendar days from receipt to make a satisfactory showing of compliance, including that they should be deemed compliant, or that the requirement does not apply to them.
What the document actually says
“If a State is unable to verify that an applicable individual has met the requirement to demonstrate community engagement under paragraph (1)”
That sentence, in plain words
The state may be unable to confirm that a person met the rule. The steps that follow say what happens then.
What this is about
The state must send a notice. The person then has 30 days. They may show they complied or that the rule does not reach them.
No action is recorded against this proposal. That is not evidence that none has been taken, and nobody has yet read it against the record. See what the tracker does not yet cover.
“the State shall notify applicable individuals enrolled under a State plan (or waiver) under this title of the requirement to demonstrate community engagement under this subsection.”
The section requires the State, under standards the Secretary specifies, to tell enrolled applicable individuals about the requirement, starting before the start date by the number of months the State specifies plus three months, and periodically after. The notice must explain how to comply, the exceptions, who is an applicable individual, what happens on noncompliance, and how to report a change in status.
What the document actually says
“the State shall notify applicable individuals enrolled under a State plan (or waiver) under this title of the requirement to demonstrate community engagement under this subsection.”
That sentence, in plain words
The state must tell people on Medicaid about the rule. That covers those the rule reaches.
What this is about
The first notice comes months before the rule bites. More follow from time to time. Each explains how to comply and what happens if you do not.
No action is recorded against this proposal. That is not evidence that none has been taken, and nobody has yet read it against the record. See what the tracker does not yet cover.
“The term `applicable individual' means an individual (other than a specified excluded individual (as defined in clause (ii)))--”
The section defines an applicable individual as someone who is not a specified excluded individual and who is eligible for or enrolled under the expansion group in section 1902(a)(10)(A)(i)(VIII), or who is eligible for or enrolled under a waiver giving coverage equivalent to minimum essential coverage and is aged 19 to 64, not pregnant, and not entitled to or enrolled for Medicare. State here means one of the 50 States or the District of Columbia.
What the document actually says
“The term `applicable individual' means an individual (other than a specified excluded individual (as defined in clause (ii)))--”
That sentence, in plain words
The term covers a person who is not on the excluded list. The tests that follow narrow it further.
What this is about
The person must be in the Medicaid expansion group. Under a waiver they must be aged 19 to 64. They must not be pregnant or on Medicare.
No action is recorded against this proposal. That is not evidence that none has been taken, and nobody has yet read it against the record. See what the tracker does not yet cover.
The document says “can”Who acts: Secretary of Health and Human ServicesHow: statuteSec. 71119 in the PDF
What the document says
“Subject to subparagraph (C), the”
The section lets the Secretary exempt a State where the State asks and the Secretary finds it is making a good faith effort to comply, weighing the actions taken, the barriers faced, the State's plan and timeline with milestones, and any other criteria the Secretary thinks right. The exemption runs for a limited period, may be ended early where the State stops reporting or stops trying, and carries reporting requirements while it lasts.
What the document actually says
“Subject to subparagraph (C), the”
That sentence, in plain words
The rule that follows is subject to a later limit.
What this is about
A state may ask to be let off for a time. The Secretary must find it is trying in good faith. The pass can be ended early.
No action is recorded against this proposal. That is not evidence that none has been taken, and nobody has yet read it against the record. See what the tracker does not yet cover.
The document says “shall”Who acts: Secretary of Health and Human ServicesHow: statuteSec. 71119 in the PDF
What the document says
“$100,000,000 for fiscal year 2026 for purposes of awarding grants under paragraph (1)(A), to remain available until expended; and”
The section requires the Secretary of Health and Human Services to award each State a grant, sized by that State's share of applicable individuals as of March 31, 2025, and to distribute a further sum equally among the States, so that States can build the systems needed to carry out this section and related eligibility work. It appropriates $100,000,000 for fiscal year 2026 for the first of those, to remain available until expended, with further amounts for the second.
What the document actually says
“$100,000,000 for fiscal year 2026 for purposes of awarding grants under paragraph (1)(A), to remain available until expended; and”
That sentence, in plain words
One hundred million dollars is set aside for fiscal year 2026. It pays for grants to the states. The money stays there until it is spent.
What this is about
Each state's grant follows its share of covered people. A second pot is split evenly. The money builds the systems the rules need.
No action is recorded against this proposal. That is not evidence that none has been taken, and nobody has yet read it against the record. See what the tracker does not yet cover.
Each distinct thing the new subsection does: require community engagement as a condition of eligibility, set the seven ways to comply, set the mandatory exceptions, require verification at redetermination with an option for more often, require ex parte verification from data the State holds, set the notice and 30 day cure process, require outreach before the rules bite, define an applicable individual, allow a State exemption for good faith effort, and fund State systems.
The full list of specified excluded individuals, the definitions of an educational program and a work program, the short-term hardship rules, and the several funding paragraphs, which are carried in summaries.
The section works by amending section 1902 of the Social Security Act and points to the Fair Labor Standards Act of 1938 and the Internal Revenue Code of 1986, none of which is indexed here.
