We've covered what the community engagement requirements are and who's exempt from them. Now the question becomes practical: how does a person actually prove it? States must verify status at application and renewal, but the rules vary widely depending on category, from permanent exclusions for veterans with total disability ratings to the shifting self-attestation window that closes for most people after 2027. The murkiest area by far is medical frailty, where CMS requires states to verify not just a diagnosis but whether that diagnosis actually prevents someone from meeting the requirement, without giving states much guidance on how. We break down the frequency rules, the paperwork expectations, and where this process is most likely to go wrong.

The paradox this creates is real. A person may be considered disabled enough that their caregiver qualifies for an exclusion, while that same person cannot qualify for an exclusion themselves.

On June 3, CMS released an interim final rule implementing Medicaid work requirements under HR 1 — and if you're enrolled in Medicaid Expansion, or through certain 1115 waivers in Georgia, Tennessee, or Wisconsin, this rule applies to you. Our latest newsletter breaks down who must comply, what activities count, and how the 80-hour monthly requirement works.

What started as a corrective action request to one state has rapidly evolved into a nationwide Medicaid enforcement campaign. In just five months, CMS has expanded from targeting Minnesota to pressuring all 50 states with provider revalidation demands, fund deferrals, and escalating anti-fraud oversight led by Dr. Oz and Vice President Vance. Here’s a breakdown of how the strategy unfolded, which states are now in focus, and what could come next for Medicaid programs — especially HCBS services.

Disability advocacy organizations often have more potential influence than they realize. The challenge is knowing how to deploy it strategically. Here is the framework we use to help organizations move from reactive to proactive on Capitol Hill.

HR 1's new Medicaid community engagement requirements take effect January 1, and CMS must release an interim final rule by June 1. One key question still unanswered: how will education count toward the 80-hour monthly standard? We examine what the statute says — and what CMS still needs to clarify.

If you’re only lobbying Congress, you’re missing where policy is actually shaped. Inside the executive branch, influence happens quietly—and earlier than most think.

New Medicaid work requirements introduce critical questions around exemptions for medically frail individuals. With updated statutory language and pending federal guidance, the application of lookback periods may play a key role in determining who maintains coverage.

What determines whether a policy idea actually moves? It’s not just the idea — it’s whether policy, politics, and process align.