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Open for Public CommentComment Period Open for Items Submitted Under the Paperwork Reduction Act as Outlined in the Community Engagement Interim Final Rule with Comment
On June 1, 2026, the Federal Register posted an interim final rule with comment period (IFC) by the Centers for Medicare & Medicaid Services (CMS). This IFC interprets and implements the community engagement requirement in Medicaid under section 1902(xx) of the Social Security Act which states that they are required to implement no later than January 1, 2027. The IFC specifies the requirements and expectations for States, specifies implementation timing, and establishes new State reporting requirements.
Within the IFC, there are eight packages that are available for public comment under the Paperwork Reduction Act (PRA) of 1995. Below is a short summary of the eight PRA packages.
Comments for the IFC and the PRA items are being accepted through July 31, 2026, and can be submitted in the following ways:
- Electronically to https://www.regulations.gov/docket/CMS-2026-2047
- By regular mail to the following address: Centers for Medicare & Medicaid Services, Department of Health and Human Services, Attention: CMS–2454–IFC, P.O. Box 8016, Baltimore, MD 21244–8016
- By express or overnight mail to the following address: Centers for Medicare & Medicaid Services, Department of Health and Human Services, Attention: CMS–2454–IFC, Mail Stop C4–26–05, 7500 Security Boulevard, Baltimore, MD 21244–1850.
Open for Public Comment
- Short-Term Hardship Exception Requests: OMB control number (CMS-10398 #101)
- States have the option to deem an individual to have demonstrated community engagement for a month when the individual experiences one of the short-term hardship circumstances and determinations of short-term hardship must be made under procedures established by the State. States electing to allow short-term hardship exceptions will be required to establish and document processes and procedures and make any corresponding technical edits to relevant systems (for example, eligibility and enrollment systems) necessary to effectuate short-term hardship exceptions and provide notice to applicable individuals.
- Beneficiary Application Updates (Single Streamlined and Presumptive Eligibility Applications), Outreach, and Noncompliance: OMB control number (CMS- 10410)
- The community engagement requirement will necessitate updates by States to their single, streamlined application; alternative single, streamlined application; associated instructions; and/or renewal-related materials, as applicable, to reflect community engagement-related information that must be communicated and collected. States that cover the adult group in their state plan will also need to make updates to their hospital presumptive eligibility and/or presumptive eligibility applications and provider training materials, including eligibility determination notices.
- States are required to develop (or update) and disseminate standardized, targeted communications notices to certain individuals about the requirement to demonstrate community engagement, and also issue a notice of non-compliance when a State cannot verify compliance with, or an exception for exclusion from the community engagement requirement. States will need to develop or update outreach and noncompliance notice templates and establish or update the associated operational workflows to support required delivery modalities and timing.
- MAGI Verification Plan Supplement: OMB control number 0938-1148 (CMS-10398 #11)
- States are required to verify compliance, deemed compliance or status as a specified excluded individual for certain adults who are eligible for, or are enrolled in, Medicaid. CMS has updated the MAGI verification plan to include a supplement specific to community engagement.
- MACPro State Plan Amendment (SPA) Submissions to Implement and Confirm Compliance OMB control number 0938-1188 (CMS-10398 #15)
- States will be required to submit a SPA (and any associated attachments) using a new, CMS-provided template to implement the community engagement requirement. SPA submissions will describe State policies and operational approaches, including who is subject to and excluded from community engagement, how states will assess compliance at application and renewal, and whether states will elect short-term hardships.
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