Hospice and palliative care patients are not explicitly exempt from recently finalized Medicaid work requirements from the U.S. Centers for Medicare & Medicaid Services (CMS)
CMS issued an interim final rule that required certain non-disabled adults on Medicaid to complete 80 hours per month of work, school or community service starting Jan. 1, 2027. This mandate applies to ages 19–64 in states with Medicaid expansion, featuring exemptions for caregivers and people with some health conditions.
However, CMS did not specifically list hospice and palliative care patients among the exemptions
“We greatly appreciate CMS’s recognition that individuals who are medically unable to meet community engagement requirements should retain access to Medicaid coverage,” said Tom Koutsoumpas, founder and CEO of the National Partnership for Healthcare and Hospice Innovation (NPHI), in a statement. “However, the rule does not provide sufficient guidance on how states should identify and exempt individuals receiving hospice care or individuals with serious illness who are actively receiving palliative care services.”
NPHI in a comment letter on the rule called for explicit guidance to ensure that those patients are exempt
Hospice and palliative care patients often face severe symptom burden, declining function, dependence on caregivers and rapidly evolving medical needs Although many may qualify for existing exemptions because of disability, medical frailty, or other serious health conditions, how federal and state officials implement the policy will determine whether beneficiaries encounter unnecessary administrative hurdles or disruptions in coverage
The requirements mandate that Medicaid beneficiaries engage in paid work, self-employment or volunteer activities for at least 80 hours per month, earning at least $580 monthly. This can include employment, at least half-time enrollment in an educational institution, community service or a combination of those
The exemptions to this rule currently include:
- Individuals younger than 19 or older than 64-years-old
- People who are blind, have a certified physical, intellectual, or developmental disability affecting activities of daily living or have a serious/complex medical condition
- Individuals with a disabling mental disorder or those with a substance use disorder (including people in treatment or recovery programs)
- Parents, guardians, or caretakers responsible for a dependent child age 13 or younger or caring for an incapacitated/disabled person
- Enrollees who are pregnant or within their postpartum recovery period
- Native Americans, Alaska Natives, former foster care youth (younger than 26) and veterans with a total U.S. Department of Veterans Affairs (VA) disability rating
- Individuals already complying with work requirements for other state and federal programs
CMS also allows for some short-term hardship exemptions
“Implementation matters,” said Ethan McChesney, senior policy director at NPHI, in a statement. “CMS and state Medicaid agencies should adopt implementation approaches that proactively identify hospice and palliative care patients and ensure they are not inadvertently subjected to community engagement requirements. They can do this by leveraging existing Medicaid eligibility, claims, encounter and provider data can help protect medically vulnerable beneficiaries while minimizing unnecessary administrative burdens for patients, caregivers and providers.”
Companies featured in this article:
National Partnership for Healthcare and Hospice Innovation
