CMS Allows Tiered Medical Frailty Determinations for Medicaid Work Requirement Exemptions

CMS has issued guidance describing an example tiered framework states may use when determining medical frailty exemptions from Medicaid work requirements. The guidance is for states implementing the federal community engagement requirement, and states are not required to use the framework. CMS describes the document as an informal summary that does not take the place of the statute, the interim final rule or formal guidance. Patient advocates warn the tiered approach could create administrative barriers that result in coverage loss for medically complex beneficiaries who struggle to navigate multi-level documentation requirements.

Managed Care