Medicaid work requirements easy to get around...

[jim584672]

...just have $580 of income a month. Any income counts!

See after page 41 in the PDF from CMS,

"Under new § 435.552(f)(2) and (g)(3), we establish that States must use the MAGI-based methodologies at § 435.603 when making income determinations for demonstrating community engagement. A contrary reading of the statute would require that States, after determining an individual income-eligible for the adult group, apply a separate and distinct income determination for such individuals in evaluating their demonstration of community engagement. There is no indication in section 1902(xx)(2) of the Act or elsewhere that the MAGI-based income provisions of section 1902(e)(14)(A) of the Act should not apply to the calculations under section 1902(xx)(2)(F) and (G) of the Act. Therefore, under § 435.552, we are interpreting section 1902(xx)(2)(F) and (G) of the Act in a manner that is consistent with section 1902(e)(14) of the Act. We specify that States must use the individual’s MAGI-based income as defined at § 435.603 in assessing an individual’s monthly income for the purpose of determining if an individual demonstrates community engagement under § 435.552(f) or (g)."

https://public-inspection.federalregister.gov/2026-11094.pdf

 

[VanWinkle]

The question is: Should the work requirements be easy to "get around"?
Should the proof needed for Medicaid be more stringent?
Without politics involved, does paying those that can't work need
more proof of the inability to work. Can 2 unmarried people with children manage to get more benefits than a married couple with children?

 

[jim584672]

I'm not going to argue the politics of what should be or not.

 

[MichaelB]

I'm not going to argue the politics of what should be or not.

Good idea

 

[VanWinkle]

Seems a little like a hit-n-run then..........

 

[Aerides]

Should the proof needed for Medicaid be more stringent?

The problem lies not in the theory (to which many would say...sure!) but in the execution. For most people who would qualify regardless, that paragraph linked above is meaningless, as they have almost nothing.

The process to document. The requirements, paperwork, access to a computer (yes libraries are free but a person with little income or mobility without access to a fantastic public transport system....my library is 7 miles away with no direct bus route there, and the nearest bus stop is one mile from my home).

Then you add frequency, how long and how often it has to be re-upped (at least every year, if not more). Perhaps some of these people have some intellectual disabilities as well. Emails get missed, bureaucracy takes months.

Inevitably, people who would and should qualify fall through the cracks and are harmed in the efforts to "catch" the few who are taking advantage. This is proven as it has happened in state cases before.

It's very easy to say "people should prove they are X to get Y" but entirely another to create a system that validates that, fairly, simply, accessibly.

 

[Sarah S]

The link is about amendments so it is impossible to tell from it what other requirements are in the original document. Usually hours spent need documentation via employment records which may be in the full regulations Do you have a link to the full document?

 

[jim584672]

The link is about amendments so it is impossible to tell from it what other requirements are in the original document. Usually hours spent need documentation via employment records which may be in the full regulations Do you have a link to the full document?

Most of the references refer to the Federal CFR.

Code of Federal Regulations (C.F.R.)

www.law.cornell.edu

 

[Sarah S]

It is pretty clear that the states will have to verify community engagement hours and not just income if you read here https://public-inspection.federalregister.gov/2026-11094.pdf

 

[MichaelB]

It is pretty clear that the states will have to verify community engagement hours and not just income if you read here https://public-inspection.federalregister.gov/2026-11094.pdf

+1

And education.

 

[jim584672]

It is pretty clear that the states will have to verify community engagement hours and not just income if you read here https://public-inspection.federalregister.gov/2026-11094.pdf

Your link is my link. The community engagement is satisfied by having the $580 in MAGI income in a month. The law does not require earned income and the new regulation makes it clear the income is defined by Medicaid MAGI rules, which means almost any income counts to meet the requirement.

 

[Sarah S]

But you can’t just have income you also need to do something and verify it - school, volunteer ,or work.

 

[MichaelB]

But you can’t just have income you also need to do something and verify it - school, volunteer ,or work.

Right, but the rigor of those tests will be determined locally.

 

[jim584672]

But you can’t just have income you also need to do something and verify it - school, volunteer ,or work.

The law does not say that:

Section 71119 OBBBA
(2) Community engagement compliance described.-
(3), an applicable individual demonstrates community engagement under this paragraph for a month if such individual meets 1 or more of the following conditions with respect to such month, as determined in accordance with criteria established by the Secretary through regulation:
``(A) The individual works not less than 80 hours.
``(B) The individual completes not less than 80
hours of community service.
``(C) The individual participates in a work program
for not less than 80 hours.
``(D) The individual is enrolled in an educational
program at least half-time.
``(E) The individual engages in any combination of
the activities described in subparagraphs (A) through
(D), for a total of not less than 80 hours.
``(F) The individual has a monthly income that is
not less than the applicable minimum wage requirement
under section 6 of the Fair Labor Standards Act of 1938,
multiplied by 80 hours. note: This is $580.
``(G) The individual had an average monthly income
over the preceding 6 months that is not less than the
applicable minimum wage requirement under section 6 of
the Fair Labor Standards Act of 1938 multiplied by 80
hours, and is a seasonal worker, as described in section
45R(d)(5)(B) of the Internal Revenue Code of 1986 .

 

[Montecfo]

It's interesting.

But are you assuming this is investment income?

Or maybe someone works 40 hours but earns twice the minimum wage?

 

[jim584672]

It's interesting.

But are you assuming this is investment income?

Or maybe someone works 40 hours but earns twice the minimum wage?

The income is defined by ACA MAGI Medicaid rules which are inclusive of investment income, pensions, Social Security, interest.

 

[zinger1457]

The changes are still open for comment for a period so it wouldn't surprise me if further clarification is made. The way it is currently written may allow someone who isn't working to meet the income requirements but it does seem clear that the intent is that the income is earned and coming from work.

 

[PlayinwithFIRE]

Isn't Medicaid funded by taxes?
Isn't income taxed?

Not sure I see the pushback.

 

[jim584672]

The changes are still open for comment for a period so it wouldn't surprise me if further clarification is made. The way it is currently written may allow someone who isn't working to meet the income requirements but it does seem clear that the intent is that the income is earned and coming from work.

Someone with some income has probably already engaged with the community to get that income to begin with.

 

[SecondCor521]

Can someone please spell out for me the potential benefit to this information? I'm not seeing any sort of potential strategy here.

Someone with investment assets that throw off $580 a month and with income below the ACA range can go on Medicaid. Okay, and then what? The only thing I can see is that it might unlock a year of larger Roth conversions at a relatively low tax cost, but that would throw you off Medicaid and back onto ACA at some point.

Since we're not talking about the political aspects of it, I'm missing what else might be the point.

 

[jim584672]

Can someone please spell out for me the potential benefit to this information? I'm not seeing any sort of potential strategy here.

Someone with investment assets that throw off $580 a month and with income below the ACA range can go on Medicaid. Okay, and then what? The only thing I can see is that it might unlock a year of larger Roth conversions at a relatively low tax cost, but that would throw you off Medicaid and back onto ACA at some point.

Since we're not talking about the political aspects of it, I'm missing what else might be the point.

There are benefits because Medicaid is monthly based while ACA is calendar year based. So it is possible to have very high income one month and qualify the next month. My state did 12 months of coverage so you are locked in. It is a great loophole.

 

[SecondCor521]

There are benefits because Medicaid is monthly based while ACA is calendar year based. So it is possible to have very high income one month and qualify the next month. My state did 12 months of coverage so you are locked in. It is a great loophole.

Right, I'm familiar with those aspects. The assumption seems to be that the person wants to be on Medicaid and/or thinks Medicaid is a better option than ACA. I think that can vary by state, by person, and by tax year.

 

[Montecfo]

The income is defined by ACA MAGI Medicaid rules which are inclusive of investment income, pensions, Social Security, interest.

I'm just trying to understand why people with material investment income would need to be on Medicaid, and also to wish to avoid the work requirements as you suggest.

What I can see is that is is assumed the work requirement is met if you meet a minimum income threshold which I assume is intended to ease administration.

 

[jim584672]

Right, I'm familiar with those aspects. The assumption seems to be that the person wants to be on Medicaid and/or thinks Medicaid is a better option than ACA. I think that can vary by state, by person, and by tax year.

Medicaid is better coverage. Total protection from Provider billing, $0 cost, $1 or $3 Rx, vision and dental, $200 max OOP a year.

You also get perks, like half price Amazon Prime, Walmart Plus, discounts on phone, electric, and Internet.

 

[MichaelB]

Can someone please spell out for me the potential benefit to this information? I'm not seeing any sort of potential strategy here.

Someone with investment assets that throw off $580 a month and with income below the ACA range can go on Medicaid. Okay, and then what? The only thing I can see is that it might unlock a year of larger Roth conversions at a relatively low tax cost, but that would throw you off Medicaid and back onto ACA at some point.

Since we're not talking about the political aspects of it, I'm missing what else might be the point.

I recall some forum members are retired early, have tax deferred retirement assets and opted for Medicaid. This may affect them.

It could conceivably require them to return to the work force.