Medicaid Work and Community Engagement Requirements

Federal law creates new Work and Community Engagement Rules for some adults who receive Medicaid through the Medicaid expansion group. A person can meet the rules through qualifying work, school, job-training, volunteer or community-service activities, or through an applicable income pathway. Some people are excluded or may qualify for another exception or temporary hardship.

If this rule applies to you, you may need to work, go to school or training, volunteer, perform community service, or meet an income standard each month to keep Medicaid coverage.

The Medicaid expansion group is a Medicaid eligibility group for certain low-income adults ages 19 through 64 who do not qualify for Medicaid through another eligibility category, such as pregnancy, disability, or age.

Not everyone who receives Medicaid is in the Medicaid expansion group.

The current federal implementation date for the Medicaid Work and Community Engagement Rules is January 1, 2027. Alaska has requested additional implementation time from the federal government.

If additional time is approved, the rules will begin later, and the Division of Public Assistance will notify Medicaid recipients of the new effective date.

The rules apply to some adults ages 19 through 64 who receive Medicaid through the Medicaid expansion group. They do not apply to everyone in that age range.

The Division of Public Assistance (DPA) will determine whether you are in the affected group and whether an exclusion, exception, or temporary hardship applies.

Being age 19 through 64 does not automatically mean the rule applies to you.

The Division of Public Assistance (DPA) will use information it already has to determine whether the rules apply to you and whether you already meet them or do not have to meet them. If DPA needs more information, it will send you a notice explaining what is needed and when it is due.

You will not have to figure this out on your own. DPA will review your information and let you know if you need to take any action.

The Division of Public Assistance (DPA) was required to send the advance notice to adults in the Medicaid expansion group because that is the group that may be affected by the new rule. Not everyone in that group will be subject to Work and Community Engagement Rules WCER.

Receiving the notice does not mean you are losing Medicaid or that DPA has determined the rules apply to you.

No. You do not need to respond to the advance notice. Keep your contact information current and watch for future Medicaid notices. If the Division of Public Assistance (DPA) needs information from you later, the notice will explain what is needed and when it is due.

No. The Medicaid Work and Community Engagement Rules apply only to certain adults in the Medicaid expansion group.
People enrolled in other Medicaid eligibility groups are not subject to these rules.

An exclusion means the Work and Community Engagement Rules (WCER) do not apply to you because you meet a specific federal category. The Division of Public Assistance must determine whether an exclusion applies before deciding whether you must meet WCER or whether another exception or hardship applies. 

Examples of people who may qualify for an exclusion include:

• Alaska Native and American Indian individuals; 
• Certain former foster care individuals under age 26; 
• Certain parents, guardians, caretaker relatives, or family caregivers; 
• Certain veterans with a total disability rating; 
• People who are medically frail or have other special medical needs; 
• Certain people subject to SNAP work rules; 
• Certain people complying with Temporary Assistance for Needy Families (TANF) work rules; 
• People participating in a qualifying drug or alcohol treatment and rehabilitation program; 
• Individuals who are inmates of a public institution; and 
• Pregnant individuals or individuals entitled to postpartum medical assistance. 

The specific rules are different for each exclusion. The questions below explain them in more detail.

If an exclusion applies to you, the Division of Public Assistance will not require you to show that you meet WCER for the period the exclusion applies. 

The Division of Public Assistance (DPA) will first review information it already has to determine whether an exclusion applies. If the available information is not enough, DPA may ask you for additional information. DPA should request documentation only when the information already available is unavailable, inconsistent, or insufficient to establish the exclusion. 

DPA will check whether an exclusion applies before asking you to show that you meet WCER.

DPA will use reliable information it already has whenever possible and avoid unnecessary repeat verification. Whether an exclusion must be checked again depends on the type of exclusion and how long the information used to establish it remains valid.

Some exclusions may need to be checked again later, while others may not.

No. Alaska Native and American Indian individuals who meet the applicable federal definition are excluded from WCER.  The Division of Public Assistance (DPA) will first use information it already has, including previously established Alaska Native or American Indian status. If the status cannot be established from available information, self-attestation may be accepted. 

Once Alaska Native or American Indian status has been established, DPA will retain that determination for future Medicaid eligibility reviews. The individual will not be required to reestablish or reverify that status.

No. An individual who is pregnant or entitled to postpartum medical assistance during the applicable period is excluded from WCER.  The Division of Public Assistance (DPA) will use information already available and will accept self-attestation of pregnancy or postpartum status. Additional documentation is not required to establish this exclusion.

Yes. The caregiver exclusion may apply to a parent, guardian, caretaker relative, or family caregiver of a dependent child age 13 or younger or a disabled individual. The specific rules depend on the caregiving situation. 

The Division of Public Assistance (DPA) will first use information already available, such as household composition, relationship, residence, and the age of a dependent child. When the caregiving relationship or other required information cannot be established through available records, self-attestation may be used as allowed by policy.

Some caregiving may still count as unpaid work toward Work and Community Engagement Rules (WCER) even when it does not qualify the person for the caregiver exclusion. Qualifying caregiving hours may be combined with other qualifying activities when allowed by Alaska policy.

Caring for a child age 13 or younger or for a disabled person may mean WCER does not apply to you.

A person who is medically frail or otherwise has special medical needs may qualify for an exclusion when the applicable criteria are met. The condition must meet the applicable medical-frailty category and significantly impair the person’s ability to reliably and consistently meet Work and Community Engagement Rules (WCER). 

A condition does not have to be visible to be considered.

A serious health condition may mean WCER does not apply to you, even if the condition is not obvious to others.

You do not have to be receiving Social Security disability benefits to be considered for this exclusion.

Not receiving Social Security disability benefits does not, by itself, prevent someone from qualifying for the medically frail or special-medical-needs exclusion. The Division of Public Assistance (DPA) will use the applicable medical and functional criteria to review the person’s circumstances. 

The Division of Public Assistance (DPA) will first use reliable information already available, including Medicaid claims, diagnoses, services, treatments, functional information, and other administrative information. If more information is needed, DPA will request only the information necessary to complete the determination.

How often the exclusion must be reviewed will depend on how long the exclusion applies.

You should not have to provide the same medical information again unless it is needed to review the exclusion.

Current participation in a qualifying drug or alcohol treatment and rehabilitation program qualifies you for an exclusion from Work and Community Engagement Rules (WCER).  The Division of Public Assistance (DPA) will first use information already available and may ask for additional information only when needed. 

You may qualify for an exclusion from WCER if you are a member of a household receiving Supplemental Nutrition Assistance Program (SNAP) benefits and are subject to an applicable SNAP work rule.

Certain veterans are. A veteran with a permanent or temporary 100% disability rating from the Department of Veterans Affairs, or who receives total disability compensation based on individual unemployability, qualifies for the exclusion. 

A permanent total disability rating does not have to be reverified once established. A temporary total disability rating is reverified at Medicaid renewal. 

Certain former foster care individuals under age 26 qualify for an exclusion. The policy applies to individuals who were in foster care and enrolled in Medicaid on their 18th birthday and who are under age 26. 

Once former foster care status is established, the Division of Public Assistance (DPA) will retain that information. The person does not have to reestablish the underlying foster care status, and the exclusion continues until the applicable age limit is reached unless reliable information shows the prior determination was inaccurate.

If DPA has already established your former foster care status, you should not have to prove it again.

An individual who is an inmate of a public institution and meets the applicable federal criteria qualifies for an exclusion from WCER.  The Division of Public Assistance (DPA) will first use available information from approved data sources, including information from the Department of Corrections and the Division of Juvenile Justice when applicable. 

The exclusion generally applies while you meet the applicable incarceration criteria.

Not necessarily. Work, education, job training, volunteer service, or other qualifying activities you are already doing may count toward the Medicaid Work and Community Engagement rules.

If the Division of Public Assistance needs more information about your activity, it will tell you what is needed and when it is due. 

Yes. Medicaid eligibility and the Medicaid Work and Community Engagement Rules are determined separately for each person.

One person in a household may be subject to the rules while another person is not.

A temporary hardship is a circumstance that may allow you to meet Work and Community Engagement Rules (WCER) without completing the usual work or community engagement activities.
Temporary hardships may include:

• Receiving inpatient or institutional care; 
• Receiving certain intensive services that are similar to inpatient or institutional care; 
• Traveling outside your community for necessary medical care for you or a dependent; 
• Living in an area affected by a qualifying emergency or disaster; or 
• Living in an area that meets the federal high-unemployment standard. 

Some hardships must be requested, while others may be applied automatically based on where you live and the circumstances affecting your area.

Certain inpatient, institutional, or similar-acuity services may qualify as a temporary hardship. This can include inpatient hospital care, nursing-facility care, certain psychiatric or behavioral-health services, and some intensive services provided outside a hospital when those services are being used instead of inpatient or institutional care. 

You may still qualify even if the care is not provided in a hospital.

Medical travel may qualify as a temporary hardship when you or your dependent must travel outside your community for necessary care that is not reasonably available where you live. Qualifying care may include medical, dental, behavioral-health, diagnostic, treatment, monitoring, or follow-up services.

Travel by air, ferry, marine transportation, or extended ground travel may qualify. An overnight stay is not always required.

A temporary hardship may apply if you live in an area affected by a qualifying federal emergency or major disaster. It may also apply if you were displaced from the affected area because of the event.

You generally will not have to prove how the emergency or disaster affected you individually if the Division of Public Assistance (DPA) can confirm that you live in, or were displaced from, the affected area.

A temporary hardship may apply if your area meets the federal high-unemployment standard and the hardship has been approved for that area. 

An area meets the federal standard when its unemployment rate is 8 percent or higher, or at least 1.5 times the national unemployment rate, whichever is lower. 

If your area qualifies, the Division of Public Assistance (DPA) will apply the hardship automatically. You will not have to show that unemployment personally prevented you from meeting WCER. 

If WCER applies to you, you may be able to meet the rules through qualifying work or other activities, education, or income. Different qualifying activities may also be combined.

There is more than one way to meet WCER.

The federal standard generally requires at least 80 hours of qualifying activities in a month. You may also meet WCER if you are enrolled in school at least half-time or if your qualifying household income meets the federal income standard.

The income standard is equal to 80 hours multiplied by the federal minimum hourly wage. At the current federal minimum wage of $7.25 per hour, the income standard is $580 per month.

Qualifying activities may include:

• Paid work; 
• Certain work or job-training programs; 
• Volunteer or community service; 
• Education; and 
• Other qualifying activities allowed under federal and Alaska policy.

Yes. Qualifying activities can be combined to reach the 80-hour standard.

Yes. Education can count toward Work and Community Engagement Rules (WCER). If you are enrolled at least half-time, as defined by your school, you may meet the education pathway. If you attend less than half-time, qualifying education hours may count toward the 80-hour standard.

School may count even if you are not enrolled full-time.

Work does not have to be a traditional salaried job to count. Self-employment and other types of work may qualify when the work or income meets the Medicaid Work and Community Engagement rules and can be verified.

The type of job matters less than whether the work meets the rules.

Yes. You may meet WCER based on qualifying household income. The federal income standard is based on 80 hours multiplied by the applicable federal minimum hourly wage. At the current federal minimum wage of $7.25 per hour, that amount is $580 per month.

Meeting Work and Community Engagement Rules (WCER) and meeting Medicaid income eligibility rules are separate matters. Whether your earnings affect Medicaid eligibility depends on your household and the Medicaid income rules that apply to you.

Meeting WCER does not automatically mean you are over the Medicaid income limit.

Yes. Seasonal or fluctuating work may count toward WCER. Qualifying income from seasonal work may be averaged over the applicable period when determining whether the income standard is met.

No. Once the Division of Public Assistance (DPA) determines that you are eligible for Medicaid and have met Work and Community Engagement Rules (WCER), you will not have to report your work or activities every month.

DPA will review WCER again at your next renewal. At that time, DPA will look only at the months that are part of the renewal review period and will first use reliable information already available. If DPA needs additional information from you, you will receive a notice explaining what is needed and when it is due.

If the Division of Public Assistance (DPA) cannot verify that you meet Work and Community Engagement Rules (WCER) using available information, you may be asked for information about your work, hours, income, education, training, volunteer or community-service activities, or other qualifying activities.

You do not need to keep the same type of records for every activity. If DPA needs additional information, the notice will explain what is needed.

The information needed will depend on what DPA is trying to verify. Examples may include employer or wage information, school or training records, or information from a volunteer or community-service organization.

DPA will not ask you to provide information that is already available to the Department.

It depends on the activity and the information DPA already has. Some information may be verified electronically. When additional information is needed, it may come from you or from another source, such as an employer, school, training program, or volunteer or community-service organization.

For some information, self-attestation may also be allowed.

DPA will first use reliable information already available. If that information shows that WCER does not apply to you or that you already meet the rules, DPA will not ask you to provide the same information again.

If the available information is not enough to make a determination, DPA will ask only for the additional information needed.

If DPA asks you for information, the notice will explain how to provide it and the deadline for responding. Information may be submitted through available DPA service channels, including Alaska Connect, mail, fax, telephone, or in person.

You will have an opportunity to provide updated or corrected information before DPA makes an eligibility decision based on information that is missing, outdated, or inconsistent.

If DPA needs additional information, it will tell you what is needed and when it is due.

If DPA cannot determine that you meet WCER or that WCER does not apply to you using other available information, not responding by the deadline could affect your Medicaid eligibility.

The notice will explain what information is needed, the deadline for responding, and your rights.

Sometimes. Whether self-attestation can be accepted depends on the information the Division of Public Assistance (DPA) needs to verify.

DPA will first use information already available. If more information is needed, DPA will tell you whether you can provide the information yourself or whether documentation is required.

If WCER applies to you, the Division of Public Assistance (DPA) will generally look at the month before the month you apply to determine whether you met the rules.

An exclusion, exception, or temporary hardship may also satisfy the rules for the applicable review period.

Once DPA determines that you are eligible for Medicaid and have met WCER, DPA will not check your WCER compliance again until your next Medicaid renewal.

At renewal, DPA will review the applicable period since your last eligibility determination. You only need to meet WCER for at least one qualifying month during that review period. 

DPA will first use information already available before asking you for additional information.

Your renewal schedule and whether the Medicaid Work and Community Engagement Rules apply to you may change if you become eligible under a different Medicaid eligibility group.

The Division of Public Assistance will determine which Medicaid eligibility group you qualify for and which renewal and Work and Community Engagement Rules apply to you.

Yes. If WCER applies to you and the Division of Public Assistance (DPA) cannot determine that you met the rules or that an exclusion, exception, or temporary hardship applies, your Medicaid application may be denied or your coverage may end at renewal.

Before taking that action, DPA must first review whether an exclusion, exception, temporary hardship, or other way of meeting WCER applies and complete the required notice steps.

Contact DPA as soon as possible. If you have proof that you submitted the information, keep it and provide it when you contact DPA.

DPA must review information received and follow applicable notice and appeal rules before denying or ending Medicaid coverage.

Yes. Your eligibility may be reviewed again if you later meet WCER or the Division of Public Assistance (DPA) determines that an exclusion, exception, temporary hardship, or other eligibility rule applies.

Yes. A Medicaid denial based on WCER may also affect whether you qualify for financial help to purchase coverage through the Health Insurance Marketplace.

If DPA denies your Medicaid application or decides to end your coverage, the notice will explain why and tell you how to request a fair hearing.

The notice will also explain the deadline for requesting a hearing and whether your Medicaid coverage can continue while the appeal is pending.   

You should report changes that may affect your Medicaid eligibility or that DPA requires you to report.

You do not need to report changes in your work or other Work and Community Engagement Rules (WCER) activities every month. DPA will review WCER again at your next renewal unless information is needed for another Medicaid eligibility reason.

Tell DPA about changes that may affect whether WCER applies or whether you meet the rules. Examples can include changes in work, school, caregiving, health, household circumstances, participation in another program, or a hardship.

Visit StayCovered.alaska.gov for current Alaska Medicaid Work and Community Engagement Rules (WCER) information. You can also call the Division of Public Assistance at 1-800-478-7778 if you need help understanding a notice or what the rules may mean for you.

Providers and community partners can help people understand Medicaid notices, identify when an exclusion, exception, or temporary hardship may apply, and provide information when DPA requests it.

They can also help individuals complete applications, renewals, and requests for additional information.

Providers may be able to provide information about a person’s condition, functional limitations, treatment needs, or other circumstances when DPA needs information to determine whether a medical exclusion or other Work and Community Engagement Rules (WCER) protection applies.