Comment on CMS-2026-2047-0002

Support for Targeted Community Engagement with Essential Disability Exemptions Docket ID: CMS-2026-2047-0002 Subject: Comment regarding the proposed "Medicaid Program: Community Engagement Requirement for Certain Individuals" I. Introduction I am submitting this comment to conditionally support the implementation of work requirements for able-bodied Medicaid enrollees under the age of 45. However, this support is contingent upon the final rule incorporating robust, inclusive exemptions for individuals with disabilities. As a concerned citizen, I have analyzed the proposed rule and believe that without explicit protections for individuals who face structural or health-related barriers to competitive employment, the agency risks issuing a rule that is arbitrary and capricious under the Administrative Procedure Act (APA), 5 U.S.C. § 706. II. Essential Exemptions to Prevent Undue Hardship To align with the intent of the Medicaid program and ensure due process, the final rule must explicitly include the following categories in its exemption criteria: Established Disability Status: Automatic exemptions for individuals currently recognized as disabled by the Social Security Administration, the Department of Veterans Affairs, or relevant state disability programs. Medical Certification: An exemption based on certification from a licensed physician confirming a lifelong, chronic, or permanent disabling condition that hinders the capacity for 80 hours of monthly employment. Self-Attestation Option: An exemption for individuals who, under penalty of perjury, declare that a medical professional has diagnosed them with a permanent disabling condition. This is critical for enrollees who may face barriers in obtaining formal paperwork due to economic or healthcare access disparities. III. Substantive Legal and Policy Rationale Statutory Authority & Nondelegation: In Loper Bright Enterprises v. Raimondo, the Supreme Court signaled an end to Chevron deference, placing a higher burden on agencies to demonstrate that their regulations fall within the clear limits of their authorizing statutes. The Social Security Act does not explicitly authorize the imposition of work requirements as a condition for Medicaid eligibility. By creating this requirement, CMS is arguably engaging in a "major question" of regulatory policy that requires clear congressional authorization. Due Process and Fairness: The agency has a constitutional obligation to provide procedural safeguards when limiting access to government benefits. Implementing a rigid 80-hour work requirement without robust, accessible disability exemptions violates the principles of due process by potentially depriving eligible, vulnerable individuals of life-sustaining medical coverage due to health conditions that are not currently captured by existing bureaucratic frameworks. Impact on Aging Populations: The agency must perform a more rigorous distributional analysis regarding individuals nearing the age of 45. Competitive employment becomes statistically less viable for this demographic due to age-related health declines, even in the absence of a formal disability diagnosis. Failing to account for this demographic reality is an administrative oversight that threatens to create significant, unintended negative impacts. IV. Conclusion Federal agencies have a duty to consider significant perspectives to ensure that administrative actions do not result in inequitable outcomes. I urge CMS to codify these specific, protective disability exemptions in the final rule. Without these measures, the rule is not only susceptible to legal challenge but fails to uphold the foundational mandate of the Medicaid program to provide a safety net for those who cannot participate in the traditional labor market.