Resources and Toolkits

Guide and tool for states to track Medicaid administrative costs of implementing H.R.1

Video outlining best practices for states to improve their risk assessment and error detection processes, including model design, review sequencing, feature engineering, review process optimization, and quick wins

Webinar on CMS Interim Final Rule (IFR) on Medicaid work reporting requirements and implications for state policymakers

JAMA Health Forum Viewpoint article examining how states can implement the Medicaid “medical frailty” exemptions under HR 1’s new work reporting requirements with recommendations for states to use flexible, clinically driven standards, multiple data sources, and priortize transparency to identify such individuals and prevent harmful coverage disruptions.

This toolkit is intended to support states in understanding and implementing H.R.1’s new copay requirements for certain Medicaid expansion enrollees that meet specific income requirements. Included is a proposed operational approach to ensure compliance with federal requirements and reduce states’ administrative burden and potential barriers for members.

Resource is intended to support states as they explain work reporting requirements in H.R. 1. It is designed to help states create clear, linguistically and culturally appropriate materials for people enrolled in or eligible for Medicaid. Each term includes a plain-language definition, alternative ways to explain it, and guidance on why clarity matters.

Issue brief outlining the strategic case for investment in monitoring, provides a phased action timeline for states to implement monitoring activities, and details potential priority monitoring domains.

Workshop to foster collaboration and share modeling practices among state agencies in response to HR1’s new SNAP PER cost share requirements. Gathering encompassed convened a group of nearly 40 research and data analytics staff from across 15 states involved in SNAP QC data modeling.

Webinar communicating new Medicaid work reporting requirements under H.R.1, highlighting how strong outreach strategies can help states protect coverage and support implementation. Experts from GMMB and Health Equity Solutions shared a communications framework and emphasized engaging enrollees in planning and message development.

Designed for state Medicaid and health and human services communications staff—particularly those responsible for planning and executing outreach related to new work reporting requirements. States can use it to inform the creation of communications efforts or to cross-reference existing plans, ensuring key tactics are considered, gaps are identified, and strategies are aligned around maintaining coverage…

Resource outlining data and analytic approaches to support states through the technology implementation and integration process for Medicaid work requirements, with a focus on medical frailty exemptions.

A CMS-developed suite of open-source tools that streamlines income and community engagement reporting for Medicaid applicants and enrollees

A sequenced, implementation-ready approach for operationalizing the medical-frailty exemption.

By Sarah Esty (Aspen Institute Financial Security Program) Phase 1: Preauthorization with simple rules, targeted reviews One state has been able to achieve a PER close to 6% through use of a preauthorization review (before cases are finalized) for all new applications, reinstatements, or cases adding a person. They have historically picked cases to review…

By Sarah Esty (Aspen Institute Financial Security Program) and Eric Giannella (Georgetown University Better Government Lab) To assist states working to rapidly reduce SNAP payment error rates to avoid new cost-share requirements, the Safety Net Response Network has been convening monthly meetings of state data practitioners for peer learning around successful error reduction strategies. Through…

Centralized hub for OBBBA Medicaid-related information for state implementation support. Features topics outlining communications and outreach, marketplace provisions, work requirements reporting, non-citizen eligibility changes, reporting and evaluation, rural health transformation, and state-specific impact estimates.

Toolkit outlining federal statutory definitions for qualifying activities and mandatory exemptions, describing criteria for ex parte verifications, and assessing need for additional application questions.

Toolkit outlining key implementation milestones for states to launch work reporting requirements including creation of governance structure, shaping policy and operational design (e.g. defining state choice for “look back period”, qualifying compliance activities, etc.), preparing staff and systems readiness, partner engagement, enrollee education, and monitoring and oversight.

Implementation details on Medicaid work requirements outlining affected populations, exemptions, compliance pathways, information on state policy choices, and implementation timeline.

Key questions for states to consider in human-centered vendor acquisition, focused on collaborative co-design and continuous feedback from enrollees and caseworkers during systems testing and development, proactive bias mitigation, accessibility, and strong data protection and interoperability standards.

Toolkit for states to define “medical frailty” work reporting requirement exemption through mechanism of alignment while aligning with CMS standards.

The passage of the One Big Beautiful Bill (also known as OBBBA or H.R. 1) in July 2025 mandated significant changes to key social safety net programs, including the Supplemental Nutrition Assistance Program (SNAP) and Medicaid. To meet these requirements and minimize coverage loss, states must update the technical infrastructure that powers their program delivery….

States can act to reduce their SNAP PERs but must move quickly for their efforts to impact their share of program costs in 2027.