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Health and Human Services Department, Centers for Medicare & Medicaid Services

Medicaid Program; Community Engagement Requirement for Certain Individuals

Published June 3, 2026. Takes effect July 31, 2026, printed at 91 FR 33348, amending 42 CFR 431, 42 CFR 435, 42 CFR 438, 42 CFR 457. 122,920 words.

In plain English

Some adults on Medicaid must work or train to keep it. This sets out how.

Read it at the Federal Register →

What the Rule Says It Does

This interim final rule with comment period (IFC) interprets and implements the community engagement requirement in Medicaid under section 1902(xx) of the Social Security Act. States are required to implement the new requirement no later than January 1, 2027. This IFC specifies the requirements and expectations for States, including the Medicaid applicants and beneficiaries who must demonstrate community engagement as a condition of their eligibility, the types of qualifying activities that satisfy the community engagement requirement, the criteria to meet an exception from the requirement (that is, be deemed compliant), and the criteria to meet a specified exclusion from the requirement. It also specifies requirements for verification of qualifying activities, outreach to affected populations, steps States must take if they determine individuals are noncompliant, and additional operational considerations for States. Finally, this IFC specifies implementation timing and establishes new State reporting requirements.

This is the rule's own summary, as the Federal Register prints it.

The Orders It Names

The rule names these orders itself. What it does about them is a reading, and none is recorded here.

On the Face of the Rule

As filed

[Federal Register Volume 91, Number 106 (Wednesday, June 3, 2026)] [Rules and Regulations] [Pages 33348-33482] From the Federal Register Online via the Government Publishing Office [www.gpo.gov] [FR Doc No: 2026-11094]

Vol. 91

Wednesday,

No. 106

June 3, 2026

Part III

Department of Health and Human Services

Centers for Medicare & Medicaid Services

42 Parts 431, 435, 438, et al.

Medicaid Program; Community Engagement Requirement for Certain Individuals; Final Rule

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

42 CFR Parts 431, 435, 438, 457, and 600

[CMS-2454-IFC] RIN 0938-AV98

Medicaid Program; Community Engagement Requirement for Certain Individuals

AGENCY

Centers for Medicare & Medicaid Services (CMS), Department of Health and Human Services (HHS).

ACTION

Interim final rule with comment period.

DATES

Effective date: These regulations are effective on July 31, 2026.

Comment date: To be assured consideration, comments must be received at one of the addresses provided below, by July 31, 2026.

ADDRESSES

In commenting, please refer to file code CMS-2454-IFC.

Comments, including mass comment submissions, must be submitted in one of the following three ways (please choose only one of the ways listed):

1. Electronically. You may submit electronic comments on this regulation to https://www.regulations.gov/docket/CMS-2026-2047. Follow the “Submit a comment” instructions.

2. By regular mail. You may mail written comments to the following address ONLY: Centers for Medicare & Medicaid Services, Department of Health and Human Services, Attention: CMS-2454-IFC, P.O. Box 8016, Baltimore, MD 21244-8016.

Please allow sufficient time for mailed comments to be received before the close of the comment period.

3. By express or overnight mail. You may send written comments to the following address ONLY: Centers for Medicare & Medicaid Services, Department of Health and Human Services, Attention: CMS-2454-IFC, Mail Stop C4-26-05, 7500 Security Boulevard, Baltimore, MD 21244-1850.

For information on viewing public comments, see the beginning of the SUPPLEMENTARY INFORMATION section.

FOR FURTHER INFORMATION CONTACT

CMS Medicaid Works, [email protected].

The fields the Federal Register prints at the head of the rule, quoted as printed. Its summary is quoted above.

Why the Agency Says It Is Doing This

SUPPLEMENTARY INFORMATION

Inspection of Public Comments: All comments received before the close of the comment period are available for viewing by the public, including any personally identifiable or confidential business information that is included in a comment. We post all comments received before the close of the comment period on the following website as soon as possible after they have been received: https://www.regulations.gov. Follow the search instructions on that website to view public comments. CMS will not post on Regulations.gov public comments that make threats to individuals or institutions or suggest that the commenter will take actions to harm an individual. CMS continues to encourage individuals not to submit duplicative comments. We will post acceptable comments from multiple unique commenters even if the content is identical or nearly identical to other comments.

The passage that opens the rule's preamble, where the agency sets out what it is doing and on what authority. Every heading that follows it is listed below.

What the Rule Contains

Every heading the Federal Register prints in this rule, in the order it prints them. 67 headings, 122,920 words in all.

  1. AGENCYOn its face · 15 words
  2. ACTIONOn its face · 7 words
  3. SUMMARYOn its face · 143 words
  4. DATESOn its face · 32 words
  5. ADDRESSESOn its face · 154 words
  6. FOR FURTHER INFORMATION CONTACTOn its face · 9 words
  7. SUPPLEMENTARY INFORMATIONPreamble · 132 words
  8. Table of ContentsPreamble · 3 words
  9. I. BackgroundPreamble · 185 words
  10. I. BackgroundPreamble · 2 words
  11. A. OverviewPreamble · 791 words
  12. B. Working Families Tax Cut LegislationPreamble · 2,249 words
  13. C. SeverabilityPreamble · 183 words
  14. II. Provisions of the Interim Final Rule With Comment PeriodPreamble · 396 words
  15. A. Decision to Revise Certain Eligibility and Enrollment Regulations To Implement Community EngagementPreamble · 1,340 words
  16. B. Applicable IndividualsPreamble · 1,390 words
  17. C. Demonstrating Community EngagementPreamble · 4,005 words
  18. 5. Enrollment in an Educational Program at Least Half-TimePreamble · 6,397 words
  19. D. Mandatory Exceptions for Certain IndividualsPreamble · 1,200 words
  20. E. Specified Excluded IndividualsPreamble · 3,269 words
  21. c. Definition of GuardianPreamble · 4,827 words
  22. 4. Veteran With a Disability Rated as TotalPreamble · 6,779 words
  23. 7. Participant in a Drug or Alcohol Rehabilitation or Treatment ProgramPreamble · 649 words
  24. 9. Pregnant or Entitled to Postpartum CoveragePreamble · 1,190 words
  25. G. Short-Term Hardship ExceptionsPreamble · 10,244 words
  26. H. Assessing Compliance With the Community Engagement RequirementPreamble · 4,203 words
  27. I. Verification of Compliance With and Exceptions and Exclusions From the Community Engagement RequirementPreamble · 14,027 words
  28. d. Veterans with a Disability Rating as TotalPreamble · 2,883 words
  29. f. Individuals Compliant With TANF Work Requirements and Individuals Not Exempt From SNAP Work RequirementsPreamble · 3,071 words
  30. J. Noncompliance ProceduresPreamble · 2,384 words
  31. c. Defining “Unable To Verify” During More Frequent Verifications of Compliance With Community EngagementPreamble · 2,098 words
  32. 6. Noncompliance Procedures and Ensuring Timely Eligibility Determinations at ApplicationPreamble · 1,065 words
  33. K. Implementation TimingPreamble · 1,229 words
  34. 3. Systems Changes Needed To Implement Community EngagementPreamble · 2,697 words
  35. L. OutreachPreamble · 3,297 words
  36. M. Managed Care ImplicationsPreamble · 1,036 words
  37. N. Additional ConsiderationsPreamble · 3 words
  38. 1. Implications of Community Engagement on Presumptive Eligibility and Presumptive Eligibility Determined by HospitalsPreamble · 1,278 words
  39. O. MonitoringPreamble · 1,170 words
  40. III. Good Cause for Proceeding With an Interim Final Rule With Comment PeriodPreamble · 447 words
  41. IV. Collection of Information RequirementsPreamble · 170 words
  42. A. Wage EstimatesPreamble · 3 words
  43. 1. States and the Private SectorPreamble · 294 words
  44. B. Adjustment to State Cost EstimatesPreamble · 135 words
  45. C. Information Collection Requirements (ICRs)Preamble · 1,128 words
  46. b. Eligibility Processing Data (Annual Reporting for Monitoring Community Engagement)Preamble · 1,353 words
  47. 3. ICRs Regarding State Plan Amendment (SPA) Submissions To Implement and Confirm Compliance (Sec. 430.10)Preamble · 330 words
  48. 4. ICRs Regarding Verification Plan Submission and Updates (Sec. 435.557)Preamble · 2,154 words
  49. 6. ICRs Regarding Short-Term Hardship Exception Requests (Sec. 435.555)Preamble · 3,431 words
  50. 7. ICRs Regarding State Requirements for Outreach (Sec. 435.561) and Noncompliance (Sec. 435.558).Preamble · 1,768 words
  51. D. Burden SummaryPreamble · 42 words
  52. E. Submission of PRA-Related CommentsPreamble · 112 words
  53. V. Regulatory Impact AnalysisPreamble · 4 words
  54. A. Statement of NeedPreamble · 419 words
  55. B. Overall ImpactPreamble · 341 words
  56. C. Detailed Economic AnalysisPreamble · 4 words
  57. 1. BenefitsPreamble · 386 words
  58. a. Medicaid Applicants and Beneficiaries Subject to the Community Engagement RequirementPreamble · 7,715 words
  59. D. Alternatives ConsideredPreamble · 1,781 words
  60. E. Accounting StatementPreamble · 102 words
  61. F. Regulatory Flexibility Act (RFA)Preamble · 136 words
  62. G. Unfunded Mandates Reform Act (UMRA)Preamble · 114 words
  63. H. FederalismPreamble · 102 words
  64. I. E.O. 14192, “Unleashing Prosperity Through Deregulation”Preamble · 123 words
  65. J. ConclusionPreamble · 32 words
  66. List of SubjectsRegulatory text · 635 words
  67. Community Engagement RequirementRegulatory text · 13,526 words

The Rest of the Text

This rule runs to 122,920 words. The rest of it is set out over 7 pages, split at the rule's own headings so that no heading is parted from the words printed under it.

How to cite this
  1. The rule itself

    Health and Human Services Department, Centers for Medicare & Medicaid Services, “Medicaid Program; Community Engagement Requirement for Certain Individuals,” 91 FR 33348 (June 3, 2026). Effective July 31, 2026.
    https://www.federalregister.gov/documents/2026/06/03/2026-11094/medicaid-program-community-engagement-requirement-for-certain-individuals

  2. This page

    “Medicaid Program; Community Engagement Requirement for Certain Individuals,” a final rule naming an order indexed here. Read the Mandate, https://readthemandate.org/rules/rule-2026-11094/ (retrieved October 10, 2026).

Cite the document when the claim is about what the document says. Cite this page when the indexing, the wording or the record of what has happened is what is being relied on.

How This Rule Is Set Out

Federal Register documents are United States government works and are not under copyright, so the rule is here whole rather than cut to an excerpt. It is split at the headings the Register itself prints: the line it is filed under, the captioned fields on its face, the preamble where the agency says what it is doing and why, and the amendments to the Code of Federal Regulations. No passage is shortened. This rule is long enough that its text is set out over 7 pages rather than one.

Two things the Register prints are not reproduced: the running head it repeats at every page break, and the tables it sets as pictures rather than as words. Its own marker for one of those tables, [GRAPHIC] [TIFF OMITTED], is left standing where the table was, so a reader can see that something is there and follow the link to the page it is on.