Resources and Toolkits

Analysis examining how states are likely to implement H.R. 1’s Medicaid provisions, including work requirements and other policies that can put eligible people at risk of losing coverage due to administrative barriers.The resource outlines key implementation timelines under both early and standard implementation scenarios, highlighting the first and last enrollee cohorts affected, major state policy…

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.

States can simplify and streamline determinations for individuals and agenciesand, reduce administrative burden, and minimize unnecessary coverage loss by leveraging the overlap in compliance activities and exemption reasons for individuals applying for or enrolled in both programs. Strategies on aligning exemptions, sharing data, and integrating verification processes highlighted through process flows and crosswalks.

CMS is offering states an open source, consent-based verification tool to streamline implementation of the Medicaid work requirement. This supports income verification for non-traditional workers, allows applicant review, and enables flexible system integration. Emmy API will also provide a single point of access for relevant data sources.

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.

Webinar session to discuss Medicaid unwinding lessons, strategies to coordinate work requirement and ex parte renewals, and methods toward designing flexible, efficient, and sustainable systems. Passcode: ^m3Q+Fuz

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

User-tested application templates and resources for Medicaid work requirements

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

Describes approaches states will take toward implementation, highlights considerations for evaluating vendors, and provides detailed descriptions of vendor products across categories (based on product demos and conversations with vendors)

Open-source community engagement reporting (OSCER) tool enables states to achieve work requirements compliance automatically using client and ex parte data, or otherwise provide link for manual certification or exemption application. Provides staff with case management and reporting tools, and sends results to state Medicaid agencies for issuance or disenrollment.

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.

Timeline of key OBBBA Medicaid policy changes, highlighting those with greatest operational impact and upcoming deadlines for state and territory agencies.

Guide on how state agencies can develop legible and flexible metrics to assess implementation of new work requirements, outlining how to build, capture, and effectively utilize metrics to monitor impact for operational awareness and decisionmaking.

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

High-level overview of Medicaid work requirements and populations subject to work requirements, key state decisions, communication and federal engagement strategy, etc.

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.

Implementation-oriented framework to support states with adapting to community engagement/work requirements. Features overview of “look back” period and four-step compliance flow including: checking for automatic hardship, screening for exemptions, checking for participation, and allowing for requestable hardship.

Evidence-based recommendations for states to optimize implementation of work requirements include: integrating compliance and exemption information and reporting into a single streamlined process, designing clear and actionable notices, utilizing text communications, and building mobile-friendly platforms.

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.

Guide explaining automatic benefit notice generation process while walking through common underlying system errors (e.g. missing or incorrect information) providing insight on how back-end design decisions cause these issues. Provides strategies to improve notice process and output such as targeted questions on system logic, workarounds for caseworkers, and structural reform through data flow, boilerplate language,…

Guide to provide states with policy and technical strategies to reduce procedural terminations under Medicaid work requirements, including simplifying verification processes, mitigating automation risks, managing vendor

Outlines strategies to reduce coverage losses including minimizing administrative and applicant burden, streamlining verification processes, creating accessible and user-friendly forms and portals, and strengthening communication and outreach efforts.

Repository of resources for state administrators to support the implementation of work requirement policies through overview of implications and recommendations of smart system designs and processes.

Features interviews from seven states on adaptation journeys in response to SNAP and Medicaid on integrated eligibility and enrollment. Insights include states awaiting federal guidance, standing up work groups, putting technology road map placeholders, prioritizing SNAP PER, making changes to end-of-life systems, rethinking data sharing, and considering population impacts.

Explainer on state IEE system fundamentals, outlining key technologies, opportunities, risks, and stakeholders involved for implementation guidance to improve benefit accessibility and efficiency.

Outlines four proactive strategies to design resilient and adaptable technical systems including feature flags, modularity, configurability, and phased approaches.

A central resource library for state, local, tribal, and territorial governments working to implement public benefits policy and system changes created through OBBBA, featuring Medicaid work requirements and SNAP PER topic sections.