# C1-2026-11094: Medicaid Now Requires Proof You're 'Engaged' to Stay Covered C1-2026-11094, Medicaid Program; Community Engagement Requirement for Certain Individuals, is a Federal Register rule from Health and Human Services Department, Centers for Medicare & Medicaid Services published 2026-06-29; deemed significant under Executive Order 12866; PRIA reads it as touching household money (as of 2026-11-13). - Canonical: https://policyrisk.com/federal-register/C1-2026-11094 - As of: 2026-11-13 - Plain-text twin of the page above; the HTML and this file carry the same facts. ## Facts - Document number: C1-2026-11094 - Title: Medicaid Program; Community Engagement Requirement for Certain Individuals - Type: Rule - Agencies: Health and Human Services Department; Centers for Medicare & Medicaid Services - Citation: 91 FR 39028 - Published: 2026-06-29 - Effective: unknown - Comments close: not stated - Significant: yes (OIRA_API) - Touches household money: yes - Regulation identifier numbers: 0938-AV98 - Last updated: 2026-11-13 ## In one line Medicaid Now Requires Proof You're 'Engaged' to Stay Covered ## Summary Starting soon, some adults on Medicaid will need to show they’re involved in their community—like working, volunteering, or training—to keep their benefits. States will use reliable info like pay records and other data to check this. This change mainly affects certain Medicaid adults and aims to make sure everyone is actively engaged, with new rules kicking in right away and possibly impacting how benefits are kept. ## Effects PRIA read - Medicaid community engagement rule: cost, high. If you are on Medicaid and are an applicable adult, you must demonstrate community engagement (for example, working, volunteering, or training) to keep coverage. The State will verify you met the requirement for the months specified in its plan before asking you for more information. - States will use payroll, claims, and data: cost, medium. States must use reliable information available to them—like payroll data, adjudicated claims from the prior 12 months, encounter data, other State or Federal agency data, and information in eligibility systems—to verify whether an applicable Medicaid individual met community engagement. The agency… - Documentation requirement starting Jan 1, 2028: cost, medium. Before January 1, 2028, States may accept other information when reliable data are not available, but beginning on January 1, 2028, States must require documentation whenever documentation is reasonably available to verify community engagement. States must accept other information only when documen… - Medical frailty verification rules: mixed, medium. For people claiming medical frailty or special medical needs, States must try to verify that status using reliable information like claims and encounter data. Before January 1, 2028, States may require documentation or accept a signed statement; beginning January 1, 2028, a signed statement under p… - 30-day noncompliance notice and timeline: mixed, medium. If a State cannot verify you met the community engagement requirement, it must give you a notice of noncompliance and a 30-calendar-day period to make a satisfactory showing. The State must continue to furnish Medicaid until the individual is determined ineligible and may disenroll the person not l… - Required connection to federal data service: cost, medium. States must obtain community engagement verification information through the electronic service established by the Secretary when available. If a new federal data source becomes available through that service, the State must connect to it or an approved alternative as soon as practicable and no lat… - Prompt enrollment while exclusions are verified: benefit, medium. If a State has enough information to verify you met the community engagement requirement but needs more information to verify you qualify for an exclusion (for example, medically frail), the State must promptly enroll you and try to verify the exclusion after enrollment or at the next redeterminati… ## Related documents - [2026-22812](https://policyrisk.com/federal-register/2026-22812): Medicare and Medicaid Programs; Cutting Administrative Requirements for Excellence in Patient Care, 2026-11-10 - [2026-22792](https://policyrisk.com/federal-register/2026-22792): Medicare Drug Price Negotiation Program and Medicare Prescription Drug Benefit Program, 2026-11-09 - [2026-22750](https://policyrisk.com/federal-register/2026-22750): Calendar Year 2027 Home Health Prospective Payment System (HH PPS) Rate Update; Requirements for the HH Quality Reporting Program and the E…, 2026-11-09 - [2026-22743](https://policyrisk.com/federal-register/2026-22743): Medicare and Medicaid Programs; CY 2027 Payment Policies Under the Physician Fee Schedule and Other Changes to Part B Payment and Coverage…, 2026-11-09 - [2026-22739](https://policyrisk.com/federal-register/2026-22739): Medicare Program: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems; and Quality Reporting Programs; i…, 2026-11-06 - [2026-22381](https://policyrisk.com/federal-register/2026-22381): Medicare and Medicaid Programs; Organ Procurement Organizations Conditions for Coverage: Revisions to the Conditions for Coverage, 2026-11-03 ## Sources - [C1-2026-11094 on federalregister.gov](https://www.federalregister.gov/documents/2026/06/29/C1-2026-11094/medicaid-program-community-engagement-requirement-for-certain-individuals) - [C1-2026-11094 as published (PDF)](https://www.govinfo.gov/content/pkg/FR-2026-06-29/pdf/C1-2026-11094.pdf) ## Related - [Previous: C1-2026-10036, Real Estate Lending Escrow Accounts](https://policyrisk.com/federal-register/C1-2026-10036) - [Next: 2026-13124, Allocation of Assets in Single-Employer Plans; Interest Assumptions for Valuing…](https://policyrisk.com/federal-register/2026-13124) - [All Federal Register documents](https://policyrisk.com/federal-register) Source: PRIA, https://policyrisk.com/federal-register/C1-2026-11094 (as of 2026-11-13).