Does having a traumatic brain injury (TBI) and PTSD automatically exempt someone from the new Medicaid work requirements?
@cheriemcgarry-hood795 asked:
Does having a traumatic brain injury (TBI) and PTSD automatically exempt someone from the new Medicaid work requirements?
Not automatically based on the diagnosis alone. CMS says people who are medically frail or have special medical needs that significantly impair their ability to meet the requirement are exempt. Whether a particular person qualifies for that exemption is determined through their state's Medicaid process.
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What You Need to Know
The new federal Medicaid community-engagement rules generally begin by January 1, 2027, although states may start earlier. They apply to certain adults ages 19–64, but federal rules include several exemptions.
One exemption is for people who are “medically frail” or otherwise have special medical needs that significantly impair their ability to comply with the work/community-engagement requirement.
That means a TBI or PTSD may be relevant, but CMS does not say that either diagnosis automatically creates an exemption in every case. States are responsible for identifying and verifying who meets an exemption.
There are also other exclusions. For example, this particular federal requirement does not apply to people who are enrolled in Medicare.
Because the determination depends on the person’s Medicaid category, state, and documentation, someone with TBI or PTSD should contact their state Medicaid agency or an authorized benefits counselor to ask how the medical-frailty exemption is being handled in their state.
Official CMS information: