Medicaid Community Engagement Verification Rules
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This correction clarifies how state Medicaid agencies must verify whether certain Medicaid enrollees meet, are exempt from, or are excluded from a community engagement requirement. States must use reliable information they already have or can access, including eligibility records, payroll data, state and federal data sources, claims, and encounter data. The practical impact is mainly on Medicaid agencies and affected enrollees, because eligibility checks may rely more heavily on existing data before asking people for new proof.
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Key Changes
- Clarifies what counts as a continuous period of Medicaid enrollment
- Defines the types of reliable information states may use to verify community engagement status
- Requires state Medicaid agencies to create processes for checking compliance, exemptions, or exclusions using available data
Obligations
What this law requires
State Medicaid agencies must verify an individual's compliance with, deemed compliance with, or exclusion from the community engagement requirement using reliable information available to the State before relying on additional proof from the individual.
State Medicaid agencies must treat reliable information available to the State as including information from electronic data sources that the agency has determined to be effective and documented in the agency's verification plan.
State Medicaid agencies must include, when available or accessible, information from other State or local agencies, Federal agency data sources, the State eligibility system, the individual's case record, payroll data, and relevant adjudicated claims from the preceding 12 months when verifying community engagement status.
State Medicaid agencies must document in their verification plan the electronic data sources they determine to be effective for verifying compliance with, deemed compliance with, or exclusion from the community engagement requirement.