Today, CCF submitted public comments on CMS’s Interim Final Rule (IFR) implementing H.R. 1-mandated Medicaid Work Reporting Requirements (WRRs). As we’ve written about time and time again, WRR policies are harmful, create unnecessary barriers to coverage, and will result in coverage losses without actually supporting work. Nonetheless, H.R. 1 has required most states to impose them as a condition of eligibility, so here we are. The IFR does little to address or mitigate known harm caused by WRRs, and in fact, goes far beyond the framework for implementing WRRs established by Congress in H.R. 1.
In our comments, we detail how some policies in the IFR weaken protections intended to shield vulnerable enrollees from losing coverage. Most notably, CMS narrowed the definition of “medical frailty” by adding a requirement that an individual’s health condition must “significantly impair” their ability to work. This standard undermines the ability for states to use data driven processes to identify individuals who are medically frail, increases paperwork burdens, and puts millions of individuals with chronic illnesses, mental health conditions, and substance use disorders (SUD) at risk of losing their health insurance. Compounding this harm, the rule severely restricts the state option to use sworn attestation for verifying exclusions, which will pose major administrative barriers for populations where formal paper documentation often does not exist, such as family caregivers or individuals. We urge CMS to broaden protections for family caregivers, pregnant individuals, and people in substance use treatment, and ensure that short-term hardship exceptions, such as disaster declarations and medical travel, are practicable. In some instances, we think CMS got it right – and we say so.
We also call for robust, public, and timely data reporting to ensure states, CMS, and the public will be able to effectively monitor the impact of WRRs and assess challenges as they undoubtedly occur. The IFR is very weak in this area, despite the often-stated commitment by the agency to “radical transparency.”
These policies leave state Medicaid agencies facing an unworkable implementation landscape. Despite widespread warnings that states need more time to prepare, including a lawsuit from 25 states and the District of Columbia following publication of the IFR, the interim final rule goes into effect this Friday, July 31, 2026. States are trapped in an unreasonably tight timeline, as they must issue communications to Medicaid enrollees by the end of August and implement by January 1, 2027.