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Medicaid work rules exempt the ‘medically frail.’ Deciding who qualifies is tricky

Indiana's Family and Social Services Administration currently deems Bloomington resident Eliza Brader medically frail, giving her expanded benefits as states define exemptions from Medicaid work requirements.
The federal law that created the work rules exempts those judged medically frail but leaves many conditions unspecified, and federal officials said they will clarify the definition next year, while state Medicaid agencies interpret the exemption with limited HHS guidance.
In practice, states vary: West Virginia allows self-reporting while North Dakota requires questionnaires and medical documentation, and Jessica Kahn warned systems and staff must be retooled to verify frailty.
The Congressional Budget Office projected the work rules will be the largest driver of coverage loss, affecting more than 18 million Medicaid enrollees while state Medicaid officials and health policy experts warn the stakes are incredibly high.
Who counts as medically frail already depends heavily on where someone lives, with eight states not expanding Medicaid and industry groups urging HHS for uniform frailty rules in a Nov. 3 letter.

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Medicaid work rules exempt the ‘medically frail.’ Deciding who qualifies is tricky

By Samantha Liss and Sam Whitehead, KFF Health News Eliza Brader worries she soon will need to prove she’s working to continue receiving Medicaid health coverage. She doesn’t think she should have to. Related Articles Affordable Care Act enrollment is slightly ahead of last year so far, despite expiring subsidies AI vs. AI: Patients deploy bots to battle health insurers that deny care After series …

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