On Thursday, August 6, the Ohio Department of Medicaid (ODM) issued notice of a public comment period on proposed rule 5160:1-4-07 – MAGI-based Medicaid: Coverage for Adults Aged 19–64 (Group VIII).
In plain language, these are the rules the state must establish to implement the federally-mandated work requirement for the Medicaid expansion group (otherwise known as Group VIII).
The ODM rules are open for public comment for the standard seven days, beginning August 6 and ending August 13. Submit comments to Rules@Medicaid.Ohio.gov.
The proposed rule provides definitions of applicable individuals, community engagement, excluded individuals (those not subject to the work and community engagement requirement), mandatory exemptions, and medical frailty (although there is still some gray area as it relates to some of the criteria). The proposed rule also clearly lays out that the review period or lookback time period, for which the individual will be assessed on work and community engagement, will be one month.
Comments should include a wide variety of impacted stakeholders and individuals
The proposed rule also reviews eligibility criteria for Group VIII and walks through what counts toward the work and community engagement requirement. While the rule begins to lay out the responsibilities of the administrative agencies involved in determining eligibility, there is less detail in this section of the rule.
Given a change of this magnitude, adding work requirements to the Medicaid program for the first time, it is important that the Department hears from a wide variety of impacted stakeholders and individuals. The time frame to respond is rapid, so we recommend clear, concise, and actionable feedback, but it is also important to raise unanswered questions and concerns. We certainly have some!
Federal IFR comments closed in July. Ohio Medicaid comment deadline is August 13.
An overarching variable related to the consideration of the state level rules is that public comments on the interim final rule (IFR) at the federal level were due on July 31, 2026, less than a week before the state rules were posted for comment.
The Centers for Medicare and Medicaid Services (CMS) has not yet provided any public response to the nearly 80,000 comments submitted on the IFR. We do not have clarity from CMS on how and what defines medical frailty. Nor do we know fully how and what will be needed to prove a medical exemption.
Language in the state-level proposed rule suggests that self-attestation—when an individual states they meet a medical frailty exemption—will not be allowed.
We know CMS would have allowed self-attestation for the first year that work and community engagement requirements are in effect. What are the implications of requiring a more stringent threshold for proving medical frailty?
Public comments on the rule are due no later than Thursday, August 13. Send comments to Rules@Medicaid.Ohio.gov. To receive notice of proposed rules, subscribe here.
The rulemaking process is how state agencies implement statutes.
This initial stage, referred to as clearance, is the internal agency review process for the proposed rule on Medicaid work and community engagement requirements before officially being filed. ODM may make changes based on the comments submitted in clearance before formally filing the proposed rule with the Register of Ohio and announcing a public hearing opportunity. The filing must occur at least 30 days before the public hearing date.
After the public hearing, ODM will prepare the rule for its legislative review with the Joint Committee on Agency Rule Review (JCARR). The rule must be approved by JCARR for final adoption. The time period for this process is carefully defined and is a consideration with the looming January 1, 2027 implementation date of the Medicaid work and community engagement requirements.
