States Lack CMS Guidance on Exempting Tribal Citizens From Work Rules
KFF Health News reports that, two months before Medicaid work requirements take effect, CMS has not given states a standardized process to identify Native Americans who are exempt under the One Big Beautiful Bill Act. CMS's June guidance told states to use existing data before requesting additional records, but set no uniform proof standard, did not require data-sharing with tribes, and left out groups like Native Hawaiians. A tribal advisory group recommended CMS let Native Americans self-attest and require states to share eligibility data with tribal health programs, but CMS has not acted on those recommendations. KFF Health News found 14 states are each developing their own verification methods, ranging from self-identification to tribal enrollment cards to data-matching with Indian Health Service records.