ECNV Submits Public Comments Opposing Medicaid Work Requirement Rule

ECNV has submitted formal comments to the Centers for Medicare & Medicaid Services (CMS) opposing the Interim Final Rule on Medicaid community engagement requirements (Docket ID CMS-2026-2047), signed by Executive Director Dominique Dunford and submitted July 31, 2026.

The letter argues that Medicaid and home- and community-based services aren't separate from community engagement — for many disabled people, they're what makes it possible in the first place. Personal assistance, transportation supports, medical equipment, and case management are often the reason someone can work, volunteer, or stay connected to their community at all, and the rule as written risks punishing people for the very barriers Medicaid is meant to address.

ECNV's central concern is the rule's medical frailty and special medical needs exclusion, which the letter argues is too narrow to protect the people Congress intended it to cover. As written, someone must prove both a qualifying condition and that the condition significantly impairs their ability to meet the requirement — a two-part test that could exclude people whose disability is real but doesn't fit neatly into that framework, including people who can work sometimes, with support, but not reliably every month.

The comments also raise serious concerns about documentation and provider verification. CMS estimates the process will take about two hours per person, but the letter points out that figure doesn't account for the real work involved: finding a provider willing to complete unfamiliar paperwork, arranging interpreters or accessible formats, or simply following up when documentation is delayed. ECNV is urging CMS to allow self-attestation when documentation isn't reasonably available, and to ensure no one loses coverage solely because a provider didn't complete a form.

Finally, the letter calls for the process to be fully accessible and compliant with the ADA and Section 504 — plain-language notices, accessible appeals, and continued coverage while someone is responding to a notice, requesting a modification, or pursuing an appeal — since even a short gap in Medicaid can interrupt care that's essential to health and independent living.

Read ECNV's full comment letter here

This work is part of ECNV's ongoing systems advocacy on Medicaid and HCBS, tracked on our Advocacy Radar page.

Update: The comment period on this rule has closed, but implementation is still unfolding — states have until January 1, 2027 to put the community engagement requirement in place. ECNV submitted formal comments opposing the rule as written, raising concerns about the medical frailty exclusion, documentation and provider verification burdens, and the need for full ADA and Section 504 accessibility throughout the process. Read our full letter and rationale here.

We'll continue monitoring how Virginia and other states implement this requirement and will share updates here as they develop.