Source: United States House of Representatives – Representative Debbie Wasserman Schultz (FL-23)
“We write to express our profound concern regarding the Centers for Medicare and Medicaid Services’ (CMS) interim final rule titled ‘Medicaid Community Engagement Requirement for Certain Individuals.’ This interim rule will create an undue burden for beneficiaries with serious health care needs and put people at risk of losing coverage, while also creating significant implementation challenges for states. Therefore, we urge CMS to revise this rule, and until such changes are made, call on CMS to authorize states to delay implementation,” wrote the lawmakers.
Washington, D.C. — Today, Representatives Joe Neguse and Debbie Wasserman-Schultz led the entire House Democratic Caucus in a letter to the Centers for Medicare and Medicaid Services (CMS), urging the agency reverse course on a new rule requiring certain Medicaid applicants and enrollees to meet conditions of eligibility in order to access critical healthcare services. The framework implements work requirements mandated by the so-called One Big Beautiful Bill Act (H.R. 1), and has the potential to lock American families facing some of the most dire health conditions out of lifesaving care.
Neguse and Wasserman-Schultz, who have each been impacted by cancer as a caregiver and patient, respectively, also called on CMS to establish, at a minimum, automatic exemptions for patients with cancer and other aggressive illnesses.
“We write to express our profound concern regarding the Centers for Medicare and Medicaid Services’ (CMS) interim final rule titled ‘Medicaid Community Engagement Requirement for Certain Individuals.’ This interim rule will create an undue burden for beneficiaries with serious health care needs and put people at risk of losing coverage, while also creating significant implementation challenges for states. Therefore, we urge CMS to revise this rule, and until such changes are made, call on CMS to authorize states to delay implementation,” wrote the lawmakers.
More specifically, CMS’s new rule makes it harder for cancer patients and survivors to qualify for Medicaid’s “medical frailty” exemption—stating that a medical condition must significantly impair a person’s ability to comply with the 80-hour per month work requirement. In their letter, the lawmakers argue this framework does not adequately consider the complex nature of illnesses like cancer, which can exhibit periodic or intermittent symptoms often relating to side effects of treatment or the disease itself.
The requirement also forces individuals to prove they can’t work, in an exhaustive process that increases barriers between struggling Americans and access to basic healthcare.
“Forcing vulnerable patients to exhaustively document their symptoms simply to maintain access to basic healthcare is both imprudent and inconsistent with Federal law. Diagnoses such as an aggressive cancer require patients to receive care as soon as possible, and as you know, any delays to treatment put patients at heightened risk. These and other rapidly progressing conditions become significantly less amenable to treatment in their later stages, meaning a patient’s current capacity to work does not reflect the urgency of their medical needs.”
The House Democratic Caucus, led by Neguse and Wasserman-Schultz, also called attention to the fact that this rule will create significant administrative and financial burdens for states. It departs from a previous definition and requires a rushed change in implementation plans.
They closed by stating that the rule goes even further than Congressional Republicans intended in their disastrous One Big Beautiful Bill Act, which already strips health care coverage from at least 17 million Americans while driving up health care costs for millions more.
The letter concluded: “While there is no way to prevent some eligible people from losing coverage due to the flawed nature of the underlying policy, which in and of itself exacts draconian cuts to healthcare programs and strips access to affordable care for millions of Americans, CMS has an obligation to implement the law in question as written. And, as noted, the new rule appears to be inconsistent with the plain language of H.R. 1, adding a new, restrictive standard that will add to the number of people losing coverage. Indeed, the evidence clearly demonstrates that creating more documentation requirements and adding complexity to the enrollment process will have a devastating effect. Therefore, in sum, we urge CMS to reconsider its interim rule to protect people with serious medical needs. CMS should also delay implementation of the new work requirements pending these changes.”
Read the full letter HERE.
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