CMS Allows Tiered Medical Frailty Determinations for Medicaid Work Requirement Exemptions
CMS has issued new rules permitting states to use tiered systems when determining medical frailty exemptions from Medicaid work requirements. The guidance affects states with approved work requirement waivers and changes how beneficiaries qualify for exemptions based on health status. The rules take effect immediately for states implementing or operating work programs. 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.
State Medicaid agencies with work requirement waivers must now decide whether to adopt tiered frailty determinations, requiring operational changes to eligibility systems and potentially increased administrative costs for case-by-case assessments.
Managed Care
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