Work Reporting Requirements: State Considerations When Defining Medical Frailty
H.R.1 provides that certain individuals, including those who are medically frail or otherwise have special medical needs, should be exempt from new Medicaid work reporting requirements. To support states in developing medical frailty definitions for work reporting requirements, the SHVS and Manatt teams developed a medical frailty toolkit that is based on a review of publicly-available policy guidance, information from states’ existing definitions of medical frailty, and research on clinical conditions. This toolkit provides a description of the factors that states may want to consider as they define the term for purposes of each of the key sub populations identified in H.R.1.
State Vaccine Toolkit
The Centers for Disease Control and Prevention (CDC) publishes recommendations for appropriate vaccine use, informed by recommendations from its Advisory Committee for Immunization Practice (ACIP). This toolkit provides an overview of key policy issue areas impacted by recent CDC/ACIP recommendations, as well as changes to the Food and Drug Administration’s approval and licensure, and provides guidance to help states support continued vaccine access and maximize flexibility on the ground.
Strategic Verification Hierarchy for Medicaid Work Reporting Requirements
States are working towards establishing a robust data verification process to meet H.R.1’s ex parte verification requirements and determine individuals’ compliance with or exemption from Medicaid work reporting requirements. As states evaluate their data sources and systems, a new IT systems’ enhancement states can consider is a verification hierarchy that enables states to efficiently identify individuals who can be exempted from or deemed compliant with work reporting requirements. This toolkit lays out a potential step-by-step strategic verification hierarchy for identifying compliance with or exemption from work reporting requirements at application. States should use this toolkit as a jumping off point as they assess their own state-specific eligibility systems’ capabilities and available data sources.
Comparing Medicaid and Supplemental Nutrition Assistance Program Work Reporting Requirements Exemptions
H.R.1 provides for certain mandatory exemptions from Medicaid work reporting requirements, including for some people enrolled in the Supplemental Nutrition Assistance Program (SNAP). As states implement Medicaid work reporting requirements, this tool can be used to identify where exemptions from Medicaid’s new work reporting requirements may overlap or relate to exemptions in SNAP to help states identify people who should not be subject to work reporting requirements in Medicaid.
Mandatory Medicaid Work Reporting: Implementation Requirements and Decision Points
While H.R.1’s mandatory work reporting requirements are prescriptive, states must still make a number of policy and operational decisions that will heavily influence whether eligible individuals are able to enroll in and retain coverage. This toolkit details the federal requirements for various features of the mandatory work reporting requirements, outlines state policy and operational options, and provides key considerations related to maximizing efficiencies and mitigating coverage losses.
Medicaid Work Reporting Requirements: Verifying Compliance and Exemptions
H.R.1’s mandatory work reporting requirements expressly direct states to use an ex parte process, relying on reliable information to verify compliance and mandatory exemptions, and avoiding requests for additional information from individuals whenever possible. To meet the aggressive timeline required by federal law to implement mandatory work reporting requirements, states can use this toolkit to support their assessment of which data sources are currently available and which data sources require new state builds and/or data matching processes.
Open Enrollment 2025 Communications Toolkit
As the open enrollment period for plan year 2026 approaches, health insurance Marketplaces face a rapidly shifting policy environment. These changes will influence the way Marketplaces engage with enrollees, community partners, and stakeholders. This toolkit is designed to help State-Based Marketplaces maintain trust with enrollees and stakeholders; communicate clearly and effectively; prepare enrollees for upcoming changes; and help enrollees maintain coverage and access care. The toolkit includes content that states can customize to reflect their voice and policy context.
Medicaid Work Reporting Requirements: Implementation Planning Milestones
H.R.1, signed into law by President Trump on July 4, 2025, requires that states implement work reporting requirements for adults ages 19 through 64 who are enrolled through Medicaid expansion or expansion-like coverage under a section 1115 demonstration. The effective date of work reporting requirements is January 1, 2027 and states will need to proactively prepare for implementation by developing comprehensive policy and operational plans that align with federal guidelines while addressing state-specific needs. The toolkit outlines the key implementation milestones that it is anticipated states will need to meet to launch work reporting requirements and a timeline for doing so.
Budget Reconciliation Implementation Roadmap
This Excel tool provides an integrated view of implementation dates for Medicaid, the Children’s Health Insurance Program, Marketplace, and Medicare provisions in the budget reconciliation law, H.R.1. Because of interdependencies with the budget reconciliation provisions, policies in the Marketplace Integrity and Affordability final rule of June 25, 2025, are also included in this timeline. This tool is intended to support states in (1) planning for timely implementation of reconciliation-driven health policy changes, and (2) effectively communicating potential impacts to communities and key stakeholders.
House Budget Bill Medicaid Proposals: State-by-State Estimates of Impacts on Expenditures and Enrollment
On Thursday, May 22, the House passed its “One Big Beautiful Bill Act” through the budget reconciliation process. As the Senate moves to take up the legislation, Manatt Health—with support and input from State Health and Value Strategies—has updated its toolkit for states, estimating the state-by-state impact over the next 10 years of most of the major provisions in the bill. The estimates take into account the interactions across the provisions included in the Manatt model.