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Ensure Family Caregivers Can Access Their Legally Afforded Exemption from Medicaid Work Requirements 

On June 1, 2026, CMS issued additional guidance to states in the form of an interim final rule (IFR) regarding implementation of work requirements (sometimes referred to as “community engagement requirements”) in Medicaid programs across the country.

These work requirements are a result of H.R. 1, the budget reconciliation bill that was signed into law in July 2025. This law outlined a small group of those who can be exempted from work requirements—called “specified excluded individuals”—including family caregivers. However, after the passage of H.R.1, questions remained around the scope of this exemption and how caregiver status would be interpreted and verified. The IFR aims to clarify some of these ambiguities.

The IFR makes key clarifications on Qualification Criteria (who qualifies as an exempt family caregiver) and Verification Pathways (how will caregiver status be verified by State Medicaid Agencies).

For an overview of these specifications, please see NAC’s Preliminary Analysis on the Interim Final Rule.

Advocacy Opportunity – Now is the Time to Act!

As states plan to operationalize work requirements and adapt to the additional restrictions detailed in the interim final rule (IFR), it is imperative that advocates engage on multiple fronts:  

CMS Interim Final Rule Comment Period – Share Your Feedback Directly with CMS 

The issuance of the interim final rule is accompanied by a public comment period during which organizations and individuals can provide direct feedback on the contents of the IFR. The comment period is open from June 3, 2026 until July 31, 2026.  

Our primary asks to CMS include: 

Require the use of a standardized assessment tool to identify family caregivers 

Why it’s important: Despite certain safeguards for family caregivers who support a relative and those who reside with the person for whom they care, we remain concerned that not all caregivers who qualify for the exemption will be afforded access to it. In many cases, documentation verifying caregiver identity may not be available or attainable. A standardized assessment instrument to identify family caregivers is critical to ensuring that caregivers have access to their legally afforded exemption from Medicaid work requirements. The usage of such a tool will also ensure the least amount of administrative burden possible. An example of such a tool can be found on page 116 of the National Alliance for Caregiving and AARP’s 2025 Caregiving in the US Report. 

Close the gap between the caregiver and medical frailty disability definitions 

Why it’s important: Within the IFR, there is a significant discrepancy between the definition of disability as it relates to the family caregiver exclusion and the definition of disability as it relates to the medical frailty exclusion. As a result, the very same disability may be recognized as significant enough to exempt the caregiver who supports that individual, while not being recognized as sufficient to exempt the individual themselves. We are urging CMS to align the disability pathway of the medical frailty exclusion with the broader definition used for the caregiver exclusion. 

Monitor and publicly report caregiver exclusion outcomes 

Why it’s important: As states begin implementing these requirements, it will be critical to understand whether family caregivers are successfully accessing the exclusions established by Congress and whether eligible individuals are experiencing coverage losses due to administrative barriers rather than ineligibility. Given the significant variation in state verification processes and the absence of a uniform caregiver self-attestation pathway, robust oversight will be particularly important for family caregivers. 

Direct Outreach to State Medicaid Agencies – Ask Medicaid Directors to Ensure Caregiver Exemption 

In conjunction with commentary provided directly to CMS, we encourage direct outreach to Governors, State Medicaid Directors, and State Aging Departments. Such advocacy has the potential for significant impact in ensuring caregivers have access to their legally afforded exemption from Medicaid work requirements. We especially urge our State Partner Network to engage with their respective state entities.  

The Caregiver Nation Coalition created a template letter that outlines several strategies that state policymakers can take to ensure family caregivers receive their legally afforded exemption from burdensome Medicaid work requirements.  

We are encourage state advocates to personalize this letter through state-specific messaging, caregiver data, and personal stories. Furthermore, NAC is ready and available to provide technical assistance in the drafting of these letters. Please email cam@caregiving.org to request additional support. 

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