Comment on CMS-2026-2047-0002

Medicaid is a federal entitlement program created to serve the public interest, not to enforce state policy preferences or economic ideology. Any eligibility condition must align with constitutional protections and the statutory purpose of the program. II. Forced Community Engagement Violates Constitutional Liberty A. 13th Amendment – Prohibition on Involuntary Servitude The proposed requirement that certain Medicaid beneficiaries perform 80 hours per month of unpaid labor or mandatory “community engagement” under threat of losing access to medical care constitutes coercive labor. The 13th Amendment prohibits: involuntary servitude compulsory service or labor any condition in which a person lacks liberty to determine their own course of action The Supreme Court has repeatedly held that coercion + threat of harm = involuntary servitude. Conditioning access to healthcare on forced labor is not permissible under any federal authority. B. 1st Amendment – Right to Free Association and Disassociation The right to free association includes the right not to associate. Mandatory community engagement forces individuals to join: workplaces volunteer organizations community groups state‑approved social structures This violates the right to assemble and the right to disassemble. Government cannot compel participation in private economic or social activity as a condition of receiving medical care. C. 14th Amendment – Liberty and Equal Protection Liberty includes autonomy, self‑direction, and freedom from state‑mandated social conformity. The proposed rule selectively imposes compulsory labor on one class of citizens—low‑income adults—while exempting others. This is discriminatory and violates equal protection principles. III. Forced Community Creates Social Harm, Not Cohesion The rule assumes that “community engagement” produces social cohesion. In reality, forced community is a driver of social conflict, misunderstanding, and alienation. When government imposes a single standard of social participation: it erases natural diversity it forces incompatible groups together it creates surveillance‑based social pressure it produces resentment rather than unity Community cannot be mandated. It must be voluntary to be meaningful. IV. CMS Must Align Medicaid Eligibility With Public Interest, Not State Policy Priorities The rule states that CMS seeks to “align Medicaid eligibility rules with state policy priorities.” This is not a lawful standard. CMS’s duty is to: uphold federal law protect beneficiaries prevent discrimination ensure access to care promote the public interest States do not have authority to impose labor conditions on federal entitlements. CMS cannot delegate constitutional violations to states. V. The Proper Role of States Is Engagement, Not Coercion If CMS wishes to encourage community engagement, the burden must fall on states, not individuals. States may: offer voluntary programs offer incentives provide training support employment pathways But they cannot compel labor or forced association by threatening medical deprivation. Any such requirement is unconstitutional. VI. Requested Action For the reasons stated above, I respectfully request that CMS: Withdraw the community engagement requirement in its current form. Affirm that Medicaid eligibility cannot be conditioned on compulsory labor or forced association. Reframe any community engagement initiatives as voluntary, supportive programs administered by states. Ensure all future rulemaking aligns with constitutional protections and the public interest. VII. Conclusion The proposed rule conflicts with the 13th, 1st, and 14th Amendments, imposes discriminatory burdens, and misunderstands the nature of community. Medicaid is a healthcare entitlement, not a labor‑discipline mechanism. CMS must protect liberty, not restrict it. I urge CMS to revise the rule to ensure that Medicaid remains a program grounded in public interest, constitutional rights, and human dignity.