Whether you're a Medicaid member, health care provider, county agency, managed care plan, community organization, or advocate, these five questions can help you identify and consider issues to raise during the public comment period.
1. Could someone actually figure this out?
Read the rule from the perspective of the Medicaid member who has to follow it. If you had never heard of "community engagement" or "medically frail," would you know what to do next?
Example: The rule allows certain volunteer activities to count toward the 80-hour monthly community engagement requirement. Does it clearly explain which volunteer activities qualify, how those hours must be documented, who can verify them, and what a Medicaid member should do if they are unsure whether an activity counts?
2. What happens if something goes wrong?
Good rules don't just explain the normal process. They also explain what happens when deadlines are missed, paperwork is lost or mistakes occur.
Example: What happens if a beneficiary submits medical documentation, but Ohio Medicaid needs more information? How will they be notified? Will they have time to respond before losing coverage?
3. Who might struggle with this?
Keep the people affected by the rule in mind. Think about someone with a serious illness, a disability, limited internet access, or someone juggling work and family responsibilities.
Example: If reporting is primarily online, what happens to someone who doesn't have reliable internet access or isn't comfortable using a computer?
4. How would someone prove they are medically frail?
Put yourself in the shoes of someone who may qualify for the medically frail exemption. Would they know what documentation they need, who can provide it, and where to get started?
Example: The rule says a person's own statement is not enough to verify that they are medically frail, but it doesn't clearly identify which health care providers can make that determination or what documentation they must submit. Would a primary care physician, nurse practitioner, psychologist, psychiatrist, licensed social worker, counselor, or substance use treatment provider qualify?
5. Will local agencies and community organizations have the tools and resources they need to support Medicaid members?
Many people will turn to their local county department of Job and Family Services, managed care plan, health care provider, or community organization to help understand these new requirements. As you read the rule, ask yourself whether it gives those organizations any new resources and sufficient direction to provide the required assistance.
Example: The rule requires community service to be performed through a structured program that tracks the type of service, the dates and hours completed, and a contact person who can verify those hours. Will local nonprofits, food pantries, churches, libraries, and other community organizations have the systems and staff needed to document volunteer hours?
Likewise, will county departments of Job and Family Services have the guidance and resources they need to answer questions, and consistently verify compliance? Ohio Medicaid states that the rule creates no new requirements for county agencies. Does the rule and described required activities support that conclusion? One thing to watch for after these rules are filed with JCARR will be the Business Impact Analysis documentation.
What happens after the public comment period closes?
The Ohio Department of Medicaid will review the comments, evaluate the legal, operational, and policy issues raised, and may revise the proposed rule in response to stakeholder feedback. The agency will then submit the rule to the Joint Committee on Agency Rule Review (JCARR), which will review the proposal in a public meeting.
If JCARR determines that the rule does not meet Ohio's statutory review standards, it may recommend that the General Assembly invalidate the rule. Stakeholders may also testify before JCARR, giving legislators an opportunity to hear concerns about the rule before it takes effect.
Remember, the public comment period is your opportunity to help shape not just what the rules say, but how they will work in the real world.
Don't be intimidated. Your experience working with Medicaid beneficiaries gives you a leg up and valuable insight into how these rules might play out in practice.
