Medical Frailty Project Workplan
Under H.R.1, states implementing Medicaid work reporting requirements must exempt individuals who are medically frail. With an effective date less than a year away, time is of the essence. The Medical Frailty Project Workplan lays out a sequenced, implementation-ready approach for operationalizing the exemption.
H.R.1 Changes to Non-Citizen Eligibility for Medicaid, CHIP, and Marketplace Coverage
On Tuesday, January 20, State Health and Value Strategies hosted a webinar on H.R.1 and the changes it will make to non-citizen eligibility for Medicaid, CHIP, and Marketplace coverage. These changes are expected to cause 1.3 million lawfully present immigrants to become uninsured and have profound consequences for many immigrants’ health and economic wellbeing. During the webinar, experts from Manatt Health provided an overview of H.R.1’s provisions that impact non-citizen coverage through Medicaid, CHIP, and the Marketplaces and highlighted implications and potential state actions to mitigate coverage loss.
Engaging Enrollees in Medicaid Work Reporting Requirements Implementation
As states work to operationalize H.R.1’s mandatory work reporting requirements for Medicaid, key implementation decisions must be made in the coming months. Strategically and intentionally engaging Medicaid enrollees early in this process can help states design efficient processes that reduce administrative burden. This toolkit provides practical strategies for engaging Medicaid enrollees in implementation decisions, including general guidelines, suggested opportunities for engagement, and sample questions and activities to support meaningful enrollee participation.
Designing Effective Verification Pathways for Exempt Populations at Heightened Risk of Coverage Loss Under Mandatory Work Reporting Requirements
H.R.1 fundamentally restructures Medicaid by conditioning eligibility for expansion adults on compliance with new work reporting requirements. States face the challenge of operationalizing at scale, and in a way that minimizes coverage loss, exemptions from Medicaid work reporting requirements for certain groups of enrollees. This toolkit offers a high-level roadmap for how states can plan to identify and protect three exempt populations.
Operationalizing the Medical Frailty Exemption: A Step-by-Step Implementation Toolkit for States
The enactment of H.R.1 introduces mandatory work reporting requirements for Medicaid expansion adults, while explicitly exempting individuals who are medically frail. The toolkit provides a step-by-step guide for how states can tackle the operationalization of medical frailty exemptions, while reducing burden on individuals and state administration and making accurate eligibility determinations.
Medicaid Managed Care Oversight Toolkit
Medicaid managed care contracts are among the largest state contracts from a financial perspective. In addition, these contracts are complex and lengthy, requiring state Medicaid agencies to have expertise, processes, and data to interpret, implement, and assess plan performance to ensure enrollee access to necessary covered services. This toolkit is designed to assist state Medicaid agencies in maximizing the value states obtain from contracted managed care entities, on behalf of enrollees and taxpayers.
Policy Changes in the Marketplaces: Monitoring Impacts
Recent federal policy actions, including H.R.1, the 2025 Marketplace Integrity and Affordability Rule, and the pending expiration of the enhanced premium tax credits, are poised to significantly reshape the health insurance landscape across all states. State-Based Marketplaces (SBMs) can be at the forefront of documenting how federal policy changes impact affordability, access, and coverage stability in their states. This issue brief outlines four priority strategies for SBMs, including a core set of recommended measures, long-term impact metrics, incorporating lived experiences through consumer surveys, and research and evaluation partnerships.
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.