Comment on CMS-2026-2047-0002
Anonymous AnonymousOpposeOther
Summary: The commenter opposes the proposed rule, arguing that it creates administrative barriers and documentation requirements that will cause people experiencing homelessness to lose Medicaid coverage. They advocate for greater state flexibility, expanded medical history lookback periods, and reduced administrative burdens on healthcare providers.
Medicaid is one of the most important sources of health coverage for people experiencing homelessness, yet the proposed HHS community engagement rule creates new barriers that could cause many eligible individuals to lose coverage.
The rule unnecessarily limits states' ability to recognize homelessness as a circumstance warranting additional flexibility. Several states have already sought or adopted exemptions for people experiencing homelessness because they understand that homelessness creates unique health and administrative challenges. HHS should allow states to establish additional medical frailty categories rather than imposing a rigid federal standard.
The proposal also creates documentation requirements that are unrealistic for people without stable housing. Many individuals experiencing homelessness have difficulty receiving mail, maintaining medical records, attending appointments, or gathering paperwork needed to prove an exemption. These administrative hurdles are likely to result in coverage losses for people who remain eligible under the law.
Restricting the use of medical records to a 12-month lookback period presents another significant problem. People experiencing homelessness often receive care intermittently or experience long gaps in treatment because of barriers such as transportation, lack of communication, or competing survival needs. Older medical records may provide the only available evidence of serious health conditions, and they should remain available when determining eligibility for exemptions.
The rule would also place substantial new administrative responsibilities on health care providers. Clinicians should be focused on diagnosing and treating patients, not completing complex paperwork or making determinations about an individual's capacity to work. These unfunded requirements would divert limited resources away from direct patient care and create unnecessary burdens for providers already serving high-need populations.
HHS should revise the rule to give states greater flexibility, reduce unnecessary documentation requirements, expand the use of medical history, and minimize administrative burdens on both Medicaid enrollees and providers. Protecting Medicaid coverage is essential to improving health outcomes and supporting housing stability for people experiencing homelessness.