Comment on CMS-2026-2047-0002

Public Comment on CMS-2454-IFC: Medicaid Community Engagement Requirement for Certain Individuals The Laboratory to Combat Human Trafficking (LCHT) appreciates the opportunity to provide comment on the Interim Final Rule implementing Medicaid community engagement requirements for certain individuals. As an anti-trafficking organization with more than two decades of experience providing training, research, and technical assistance to professionals across multiple sectors, we offer the following perspective regarding vulnerability to exploitation and human trafficking. The new Medicaid community engagement requirement generally conditions eligibility for certain adults on demonstrating at least 80 hours per month of work, education, volunteer service, or other qualifying activities. LCHT opposes this proposed requirement. LCHT encourages CMS to carefully examine whether community engagement requirements may unintentionally increase vulnerability among populations already at heightened risk for labor trafficking, sex trafficking, forced criminality, and other forms of exploitation. Individuals experiencing poverty, unstable housing, family violence, behavioral health challenges, substance use disorders, prior victimization, or economic coercion may face barriers to maintaining compliance with reporting requirements or securing qualifying activities. Loss of healthcare coverage could further exacerbate instability and increase dependence on unsafe employment arrangements or exploitative relationships. Of particular concern is the potential for community engagement requirements to increase susceptibility to labor exploitation. When individuals face pressure to quickly secure documented work, volunteer placements, or other qualifying activities in order to preserve healthcare benefits, they may have fewer opportunities to carefully evaluate employment offers or verify the legitimacy of recruiters, employers, or work arrangements. This dynamic may increase vulnerability to deceptive recruitment practices, wage theft, labor trafficking, fraudulent employment schemes, misclassification, and other forms of exploitation. Individuals facing urgent economic or healthcare needs are often less able to decline unsafe working conditions, challenge labor violations, or leave potentially exploitative situations. We are also concerned about the potential risks associated with volunteer or community service pathways used to satisfy eligibility requirements. Individuals who must obtain and document volunteer hours in order to maintain healthcare coverage may face increased pressure to accept unpaid or poorly supervised work opportunities. While community service can provide meaningful benefits, safeguards should be established to ensure that these arrangements do not create opportunities for coercion, exploitation, abuse, or the displacement of paid labor. LCHT respectfully recommends that CMS: 1. Incorporate trafficking vulnerability, labor exploitation risk, and deceptive recruitment practices into implementation and evaluation efforts. 2. Ensure broad, accessible exemptions and accommodations for individuals experiencing trafficking, domestic violence, behavioral health conditions, homelessness, or other significant barriers. 3. Provide trauma-informed guidance and training for agencies responsible for determining compliance, including information on indicators of labor trafficking and exploitation. 4. Monitor and publicly report on unintended consequences, including coverage loss among vulnerable populations and any indicators of increased labor exploitation or fraudulent employment activity. 5. Engage victim service providers, labor rights organizations, anti-trafficking organizations, and survivor-informed stakeholders as implementation proceeds. Healthcare access is a critical protective factor that promotes safety, stability, and long-term resilience. As CMS implements the community engagement requirement, we encourage the agency to proactively assess and mitigate any unintended consequences that could increase vulnerability to exploitation among low-income individuals and families. Thank you for your consideration.