July 31, 2026
Administrator Mehmet Oz
Centers for Medicare & Medicaid Services
Department of Health and Human Services
7500 Security Boulevard
Baltimore, Maryland 21244-8016
Re: RIN 0938-AV98; CMS-2454-IFC
Medicaid Program; Community Engagement Requirement for Certain Individuals
Dear Dr. Oz,
The Partnership for Inclusive Disaster Strategies (The Partnership) is the only U.S. disability-led nonprofit organization that focuses on the rights, needs, and inclusion of people with disabilities and people with access and functional needs throughout all planning, programs, services, and procedures before, during, and after disasters and emergencies. We achieve our mission through disability-led disaster response and community resilience; community engagement, organizing, and leadership development; advocacy and systems change; training, technical assistance, and research; and unwavering support for local disability organizations.
The Partnership is a convener for local disability organizations, advocates, emergency managers, public health officials, federal, state/territorial and local government agencies, first responders, and allies across the country to address the urgent needs and systemic gaps and barriers people with disabilities face before, during, and after disasters and emergencies. We recognize that civil rights are not suspended during disasters.
Disasters and public health emergencies are increasing in frequency, duration, and intensity, and disabled people are disproportionately impacted in disasters. In fact, we are 2-4 times more likely to be injured or die in disasters than nondisabled people. Disabled disaster survivors have increased health care needs. Without Medicaid coverage and home-and community-based services (HCBS), these medical conditions will become exacerbated, increasing the risk of preventable hospitalization, and could lead to costly and unwanted institutionalization in nursing and psychiatric facilities, or death. Returning to the community once institutionalized can be extremely difficult. Disabled people lose housing, jobs, and sometimes support systems when they are institutionalized. Two out of three people between 60 and 79 say they would rather remain at home as they age. HCBS is cost effective. Medicaid expenditures for an individual average 54,462. in an institution, as opposed to 17,298. per person for HCBS.
In order to curtail unwanted institutionalization, CMS should also require continuity of Medicaid coverage throughout declared emergencies and recovery periods in the declared states and if survivors have to cross state/territory lines.
We are deeply concerned about the consequences of the Interim Final Rule with Comment Period (IFC) on disabled disaster survivors, including older adults. The Medicaid work requirement rule will have a devastating effect on the lives of disabled people. It will be detrimental to our health and cost many of us our lives. The last minute decision to include a complex, two-part medical frailty test with narrow, yet vague guidelines will not protect disabled Medicaid enrollees. It will do the opposite. Requiring disabled enrollees with disabilities who are not receiving SSI or SSDI to satisfy a two-part test where they must first demonstrate that they have a qualifying condition, and then that this condition stops their ability to work, go to school, or provide community service is overly burdensome. Data alone will not satisfy this test. Many clinicians, including those with long-term relationships with their patients, may struggle to interpret and consistently apply these new standards, creating additional barriers for eligible individuals. Self-attestation would lessen this burden somewhat, however it will only be permissible through 2028. These rigid requirements in the IFC extend even beyond the requirements of section § 71119 of OBBBA.
The IFC will cause countless disabled people to be cut off from Medicaid, not because they don't qualify, but because they got caught in the bureaucratic quagmire imposed by the rule. As was seen in the 2023 and 2024 Medicaid unwinding the reason that most people lost benefits was not due to ineligibility, but because of administrative barriers such as lost letters or changed addresses and phone numbers. People also become overwhelmed with paper work and other burdensome duties of the rule. This will be particularly true of disabled disaster survivors.
The rule will discourage disabled people who are employed or could be employed part- time from working out of fear that once they have demonstrated that they have some ability to work, they will be cut off from Medicaid.
The work requirements will have a catastrophic cascading effect on disabled people, that will be particularly dangerous for disabled disaster survivors. During and after disasters, it is often impossible to keep up with any paperwork let alone burdensome Medicaid eligibility requirements. Further the ICF will lead to the closing of even more rural hospitals leaving disabled people with no options for medical care. This will be particularly impactful in the wake of increasing disasters. Currently Medicaid is the insurer of 1 in 5 patients in rural hospitals and approximately 50 percent of births. Again, this will have a disproportionate impact on disabled disaster survivors.
Thank you for this opportunity to comment.
PIDS Comments on Medicaid Work Requirements
Posted: July 31, 2026 by admin
July 31, 2026
Administrator Mehmet Oz
Centers for Medicare & Medicaid Services
Department of Health and Human Services
7500 Security Boulevard
Baltimore, Maryland 21244-8016
Re: RIN 0938-AV98; CMS-2454-IFC
Medicaid Program; Community Engagement Requirement for Certain Individuals
Dear Dr. Oz,
The Partnership for Inclusive Disaster Strategies (The Partnership) is the only U.S. disability-led nonprofit organization that focuses on the rights, needs, and inclusion of people with disabilities and people with access and functional needs throughout all planning, programs, services, and procedures before, during, and after disasters and emergencies. We achieve our mission through disability-led disaster response and community resilience; community engagement, organizing, and leadership development; advocacy and systems change; training, technical assistance, and research; and unwavering support for local disability organizations.
The Partnership is a convener for local disability organizations, advocates, emergency managers, public health officials, federal, state/territorial and local government agencies, first responders, and allies across the country to address the urgent needs and systemic gaps and barriers people with disabilities face before, during, and after disasters and emergencies. We recognize that civil rights are not suspended during disasters.
Disasters and public health emergencies are increasing in frequency, duration, and intensity, and disabled people are disproportionately impacted in disasters. In fact, we are 2-4 times more likely to be injured or die in disasters than nondisabled people. Disabled disaster survivors have increased health care needs. Without Medicaid coverage and home-and community-based services (HCBS), these medical conditions will become exacerbated, increasing the risk of preventable hospitalization, and could lead to costly and unwanted institutionalization in nursing and psychiatric facilities, or death. Returning to the community once institutionalized can be extremely difficult. Disabled people lose housing, jobs, and sometimes support systems when they are institutionalized. Two out of three people between 60 and 79 say they would rather remain at home as they age. HCBS is cost effective. Medicaid expenditures for an individual average 54,462. in an institution, as opposed to 17,298. per person for HCBS.
In order to curtail unwanted institutionalization, CMS should also require continuity of Medicaid coverage throughout declared emergencies and recovery periods in the declared states and if survivors have to cross state/territory lines.
We are deeply concerned about the consequences of the Interim Final Rule with Comment Period (IFC) on disabled disaster survivors, including older adults. The Medicaid work requirement rule will have a devastating effect on the lives of disabled people. It will be detrimental to our health and cost many of us our lives. The last minute decision to include a complex, two-part medical frailty test with narrow, yet vague guidelines will not protect disabled Medicaid enrollees. It will do the opposite. Requiring disabled enrollees with disabilities who are not receiving SSI or SSDI to satisfy a two-part test where they must first demonstrate that they have a qualifying condition, and then that this condition stops their ability to work, go to school, or provide community service is overly burdensome. Data alone will not satisfy this test. Many clinicians, including those with long-term relationships with their patients, may struggle to interpret and consistently apply these new standards, creating additional barriers for eligible individuals. Self-attestation would lessen this burden somewhat, however it will only be permissible through 2028. These rigid requirements in the IFC extend even beyond the requirements of section § 71119 of OBBBA.
The IFC will cause countless disabled people to be cut off from Medicaid, not because they don't qualify, but because they got caught in the bureaucratic quagmire imposed by the rule. As was seen in the 2023 and 2024 Medicaid unwinding the reason that most people lost benefits was not due to ineligibility, but because of administrative barriers such as lost letters or changed addresses and phone numbers. People also become overwhelmed with paper work and other burdensome duties of the rule. This will be particularly true of disabled disaster survivors.
The rule will discourage disabled people who are employed or could be employed part- time from working out of fear that once they have demonstrated that they have some ability to work, they will be cut off from Medicaid.
The work requirements will have a catastrophic cascading effect on disabled people, that will be particularly dangerous for disabled disaster survivors. During and after disasters, it is often impossible to keep up with any paperwork let alone burdensome Medicaid eligibility requirements. Further the ICF will lead to the closing of even more rural hospitals leaving disabled people with no options for medical care. This will be particularly impactful in the wake of increasing disasters. Currently Medicaid is the insurer of 1 in 5 patients in rural hospitals and approximately 50 percent of births. Again, this will have a disproportionate impact on disabled disaster survivors.
Thank you for this opportunity to comment.
Category: Uncategorized