Medicaid MCOs Prepare for 2027 Community Engagement Requirements Under HR 1
The Reconciliation Act (HR 1) established community engagement requirements for non-elderly, nonpregnant Medicaid adults effective 2027. CMS has released an implementation framework detailing how states must operationalize work requirements for beneficiaries aged 19-64. Health plans cannot contract directly with states to administer these requirements, but managed care organizations are developing member engagement and support strategies to maintain enrollment and help beneficiaries comply. The requirements will affect eligibility determination, member outreach, and care coordination workflows across Medicaid MCOs.
Medicaid MCOs must redesign member engagement strategies, care coordination processes, and reporting systems to support beneficiaries in meeting community engagement requirements while managing potential enrollment volatility and revenue impact starting in 2027.
Managed Care
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