AAMC Responds to CMS Medicaid Work Requirements Rule 

The AAMC issued a June 3 statement responding to an interim final rule (IFR) issued by the Centers for Medicare & Medicaid Services (CMS) implementing section 71119 of the One Big Beautiful Bill Act (OBBBA, P.L. 119-21, PDF), which requires states to apply “community engagement” or work requirements for certain Medicaid enrollees. In its statement, the association underscored that the IFR exceeds the statutory framework established by the OBBBA and called upon the agency to modify these provisions to allow states greater flexibility in implementing work requirements. The CMS originally issued initial guidance for states on implementing Medicaid work requirements in December 2025 [refer to Washington Highlights, Dec. 12, 2025]. Comments on the IFR are due by July 31.    

The IFR seeks to establish standards for states in their implementation of the OBBBA’s work requirements. These standards include expectations for eligibility determinations, exemptions, verification, and state reporting requirements. Under the OBBBA, states must exempt from work requirements individuals who are pregnant, postpartum, disabled, medically frail, American Indian or Alaska Native, parents or caregivers of children 13 years and younger, and people with disabilities, in addition to other categories of individuals. The agency adopted a definition of “medically frail” to mean an enrollee who has diminished functional capacity that significantly impairs their ability to meet work requirements. Medicaid enrollees can self-attest to compliance with the medical frailty exemption, without submitting additional documentation, until Jan. 1, 2028. After this point, the agency will only allow for one self-attestation during the enrollee’s period of enrollment. For any redetermination after this point, states will be effectively prohibited from using the self-attestation option and will be required to request documentation from enrollees verifying that they meet an exemption. This goes beyond the language of the statute, which requires the CMS to give states the option to allow enrollees to self-attest to meet an exemption without providing additional documentation (Section 1902(xx)(3)(A) of the Social Security Act).