CMS Recommends Three-Tiered Approach For Medical Frailty Exemption To Medicaid Work Requirements

The Centers for Medicare & Medicaid Services (CMS) issued new guidance recommending that states use a three-tiered, data-driven approach to identify Medicaid expansion beneficiaries who qualify for a medical frailty exception from federal work and community engagement requirements. The approach uses ICD-10 diagnosis codes, additional health care and utilization data, and manual reviews when needed to determine whether a physical, mental, or behavioral health condition significantly impairs an individual's ability to meet the requirements. States are not required to adopt the recommended framework and may use another data-driven approach. The federal community engagement requirement takes . . .