CMS Releases Guidance to States on Medicaid Work Requirements and Medical Frailty

As states prepare to implement new Medicaid work reporting requirements, the Centers for Medicare & Medicaid Services (CMS) recently hosted a webinar focused on the application of medical frailty exemptions. Slides from the presentation were distributed to states on September 8, 2026.

Work reporting requirements are applicable to the Medicaid Expansion population, those between 19 and 64, with income slightly over legacy eligibility requirements. The compliance deadline for states to implement the policy is January 1, 2027.

During the call, CMS outlined optional steps states can take to verify medical frailty for exemption from work requirements, providing a three-tiered option as an available framework for establishing exemption. CMS also shared potential data sources and medical codes for consideration, as well as examples in an effort to help states understand their options and obligations. Though more information was and remains necessary on how CMS intends to support states in implementing community engagement medical frailty exemptions, the slides provide little new information, with examples not addressing the harder-to-determine grey areas, but providing obvious examples of exemption eligibility within tiers. Additionally, the guidance provides no information to states about how claims data can actually demonstrate an individual's ability to work, as was required by the interim final rule. The slides and call come quite late in the timeline for states.

With the January 1 compliance date, states are already communicating with enrollees to whom the new requirements apply. Pivoting to a new policy practice on medical frailty exemptions would add complexity to an already capacity-limited policy and timing challenge. States opting to accept self-declaration of exemption eligibility could find limited utility in the CMS presentation, with longer timelines to finalize exemption criteria prior to a concrete ex parte process by 2028.