Medicaid
CMS says it will appeal ruling that eased the Medicaid 'medically frail' exemption
Medicare and Medicaid chief Mehmet Oz says the agency will fight last week's court decision, which made it easier for seriously ill adults to be excused from new Medicaid work rules starting January 1.
Key facts
- CMS plans to appeal the October 29 ruling.
- The easier exemption standard applies for now.
- Work rules for adults 19 to 64 still start January 1, 2027.
What happened
CMS Administrator Mehmet Oz said on CNBC on November 3 that the agency will appeal last week's federal court decision on the "medically frail" exemption from Medicaid work requirements, according to InsideHealthPolicy. He called it a fundamentally important question that could reach the Supreme Court.
On October 29, a federal judge in Boston blocked a federal rule that would have made people prove their condition significantly impairs their ability to work before they could be exempted. New York was one of 24 states, plus Washington, D.C., that sued. A KFF analysis says the ruling applies nationwide. For now, a person only needs a condition in one of the categories listed in the law, and states may accept a person's own statement in 2027. The judge left other parts of the rule in place, and the work requirements still begin January 1, 2027.
What it means for families
The easier exemption is in effect today, but an appeal means the rules could change again. Families should not assume the current standard will last all year.
People 65 and older are not subject to the work rules. The people most affected are adult children, spouses and family caregivers ages 19 to 64 who have Medicaid and live with a serious illness or disability.
New York has not yet said exactly how it will check for medical frailty. Watch for letters from your county Department of Social Services or NY State of Health.
What to do this week
- Open and answer every Medicaid letter, especially renewal notices.
- Keep a current list of diagnoses, medicines and doctors for anyone who may qualify for the exemption.
- Make sure Medicaid has your current address and phone number.
Sources
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