CMS 宣布 Medicaid 工作要求设无害过渡期：2027年6月30日前不因未达标拒批或取消资格
美国联邦医疗保险和医疗补助服务中心（CMS）11月13日宣布，为实施医疗补助（Medicaid）工作要求的各州设立一段自愿采用的无害过渡期（hold harmless period），持续至2027年6月30日。采用过渡期的州仍会评估申请人与受益人是否满足工作要求或属于豁免人群，但在过渡期内不得仅因未达到工作要求而拒绝申请或取消其他方面符合资格者的保障。
按照联邦法律，自2027年1月1日起，19至64岁的部分 Medicaid 申请人与受益人须满足工作要求，除非属于豁免人群。达标方式包括每月从事工作、社区服务或参加工作项目满80小时，至少半日制就读教育项目，多种达标活动合计满80小时，或达到规定的月收入门槛。CMS 今年6月发布的中期最终规则已列明上述要求的具体口径。
CMS 表示，这段过渡期让各州有时间继续改进系统与流程、梳理申请人与受益人的办理体验，并在正式执行前从最初几个月的实施中发现问题、培训工作人员。CMS 同时强烈鼓励各州优先用州政府已有可靠数据自动核验达标活动与豁免资格，减少让申请人反复提交纸面证明；把通知写清楚，说明州政府已经核实了什么、还需要什么、如何回应或求助；并在正式执行前对数据比对、通知与资格决定做全流程测试。
CMS 医疗补助与儿童健康保险计划中心主任 Dan Brillman 表示，各州已经取得切实进展，也明确告诉联邦政府，要把这件事为受益人做对、做得可持续需要什么条件：如果州政府能用数据表明某人正在工作或符合豁免条件，这个人就不应再去四处找纸面证明；当一个人需要支持时，应当清楚知道该做什么、何时做、去哪里求助。
CMS Announces Hold Harmless Period for Medicaid Work Requirement Through June 30, 2027
The Centers for Medicare & Medicaid Services (CMS) announced on November 13 an optional hold harmless period through June 30, 2027, for states implementing the Medicaid work requirement. States that adopt the transition period will still assess whether individuals meet the work requirement or qualify for an exclusion, but they will not deny applications or disenroll otherwise eligible individuals solely for failure to meet the requirement.
Under federal law, beginning January 1, 2027, certain Medicaid applicants and beneficiaries ages 19 to 64 must meet a statutory work requirement unless excluded. Qualifying activities include 80 hours per month of work, community service, or participation in a work program; enrollment in an educational program at least half-time; a combination of qualifying activities totaling at least 80 hours per month; or meeting a specified monthly income threshold. CMS set out the details in an interim final rule issued in June 2026.
CMS said the transition period gives states time to further modernize systems, improve processes, and streamline the applicant and beneficiary experience, and to learn from the early months of implementation before enforcement begins. The agency also strongly encouraged states to maximize automated verification using reliable data they already hold, to give people clear and timely notices explaining what has been verified and what is still needed, and to test end-to-end processes before enforcement.
“States have made real progress, and they’ve been clear with us about what it takes to get this right for beneficiaries, at scale and for the long term,” said Dan Brillman, Deputy Administrator and Director of the Center for Medicaid and CHIP Services. “If the state can use data to show that someone is working or qualifies for an exclusion, that person should not have to track down paperwork to prove it.”
来源：美国联邦医疗保险和医疗补助服务中心
发布：GSM·美国（发布链接）
图片来源：图：美国卫生与公众服务部总部休伯特·汉弗莱大楼（华盛顿），联邦医疗保险和医疗补助服务中心（CMS）为其下属机构。ajay_suresh 摄，CC BY 2.0，经 Wikimedia Commons。 / Photo: The Hubert H. Humphrey Building in Washington, headquarters of the U.S. Department of Health and Human Services, the parent agency of CMS. By ajay_suresh, CC BY 2.0, via Wikimedia Commons.
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