Beginning in 2027, Medicaid members — primarily those eligible for coverage through the Affordable Care Act Medicaid expansion — will be required to meet work-related or community engagement requirements to maintain their Medicaid coverage. These federal Medicaid work requirements, established through the 2025 budget reconciliation bill, include exemptions for certain groups, including medically frail individuals.

This tipsheet draws on lessons shared by experts from the Harvard T.H. Chan School of Public Health, the Aspen Institute Financial Security Program, and Katch Strategies during a state-only Medicaid Work Requirements: Tech Implementation and Integration Learning Series in March 2026 that focused on data and analytic approaches for the medical frailty exemption. It features implementation considerations that can help streamline state adoption of the medical frailty exemption and minimize Medicaid application and renewal barriers for medically frail individuals.