Comment on CMS-2026-2047-0002

I am concerned that the Medicaid Community Engagement Requirement may create barriers to healthcare coverage for vulnerable individuals who rely on Medicaid for essential medical care. While encouraging employment and community participation is an important goal, many Medicaid recipients face health, social, and economic challenges that make it difficult to consistently meet reporting requirements. Individuals living with chronic illnesses, including HIV, may experience periods of illness, treatment side effects, mental health challenges, housing instability, transportation barriers, or other circumstances that interfere with compliance even when they remain actively engaged in their healthcare. Experience from previous work requirement programs has shown that eligible individuals can lose coverage because of administrative and reporting barriers rather than because they are unwilling to work or participate in their communities. I respectfully urge CMS to take additional steps to protect access to healthcare by: • Including HIV/AIDS as a specified exclusion or automatic exemption under the Medicaid Community Engagement Requirement; • Minimizing administrative and reporting burdens that can result in eligible individuals losing coverage; • Simplifying exemption and verification processes for people with chronic health conditions; • Monitoring the impact of the policy on healthcare access and health outcomes; and • Ensuring that individuals do not lose access to life-saving medications, preventive care, mental health services, and other essential healthcare services due to paperwork or reporting challenges. Medicaid is a critical source of healthcare coverage for millions of Americans. Policies designed to promote community engagement should not inadvertently create barriers to care for individuals who depend on Medicaid to manage chronic health conditions and maintain their health and independence. Thank you for considering these comments.