HF4428

Purpose

This bill adds community engagement requirements to the Medical Assistance (MA) program (Minnesota Medicaid). It requires people who are eligible for MA to demonstrate certain activities each month to qualify for and maintain benefits, with a system for exceptions, hardship provisions, and outreach. It also changes how certain data related to employment and benefits can be shared among state agencies to support program administration and enforcement.

Main provisions

• What counts as community engagement
  • An eligible MA applicant or recipient (an “applicable individual”) must show compliance with the community engagement requirements during the application and renewal process, or have an approved exception.
  • In a given month, an applicable individual must meet at least one of the following for a minimum of 80 hours:
  • Work at least 80 hours
  • Complete at least 80 hours of community service
  • Participate in a work program
  • Enroll at least halftime in an educational program (e.g., college or technical education)
  • Any combination of the above totaling 80 hours
  • Have monthly income at least equal to the federal minimum wage times 80 hours, or have an average monthly income over the prior six months at least that amount if they are a seasonal worker
• Exceptions (who does not have to meet engagement requirements)
  • Categories include: certain MA enrollees, American Indians/Alaska Natives eligible as an Indian for the Indian Health Service, a parent/guardian of a dependent child under 13 or of someone with a disability, a veteran with a total disability, a SNAP recipient not subject to a work requirement, participants in certain treatment programs, inmates, and individuals who are medically frail or have significant medical needs as defined by federal guidance.
  • The commissioner will create standard forms for requesting exceptions based on medical frailty or physical/mental unfitness for employment. Recipients must report status changes within 10 days, and the county agency will redetermine eligibility when exception status changes or at renewal.
• Short-term hardship exceptions
  • The commissioner must deem a person compliant in a month if they have to receive inpatient hospital/nursing facility/ICF services or must travel outside their community to receive necessary medical care, or if the county faces certain emergency or unemployment circumstances and the federal guidance allows an exception.
• How compliance is determined and verified
  • The commissioner uses data matching and other electronic data sources to determine whether someone is compliant or under an exception.
  • The determination must rely on information already available; it should not rely on managed care plans or contractors with financial ties to such plans.
• Consequences for noncompliance
  • If compliance can’t be established within a 30-day notice period, the applicant/recipient will be informed and given time to demonstrate compliance or secure an exception.
  • An enrolled MA recipient remains eligible during the 30-day period. If noncompliance continues after the period, the agency will consider other eligibility bases or deny/terminate MA by the end of the next month.
  • If there is continued noncompliance and no other eligibility basis exists, MA benefits can be denied or terminated.
• Outreach and notification
  • By Sept. 1, 2026, the commissioner must notify MA enrollees who may be applicable individuals about the community engagement requirements.
  • Beginning Jan. 1, 2027, the commissioner must provide semiannual notifications to MA enrollees about the requirements.
  • Notices must include how to comply, who is considered an applicable individual, a list of exceptions and how to obtain them, how to report changes, and the consequences of noncompliance.
  • Notices must be sent by mail or other electronic formats if the enrollee chooses.
• Commissioner duties and supports
  • The commissioner, with county agencies, must implement strategies to help applicable individuals meet the requirements and connect them to job training, child care, transportation, and other supports to prepare for work, maintain employment, or increase earnings.

Significant changes to existing law

• New MA eligibility requirement
  • The bill adds a mandatory “community engagement” requirement to MA eligibility and renewal, with defined activities and hours, and a structured exception framework.
• Data-driven enforcement
  • It broadens and formalizes data sharing and data matching across state agencies to verify compliance and manage exceptions, relying on electronic sources rather than plan-based determinations.
• Expanded data-sharing provisions
  • The bill revises sections related to wage data and data sharing (including with the Department of Human Services, Department of Revenue, and other agencies) to support eligibility determinations, program integrity, and cross-program reporting (e.g., MA, SNAP, child support, tax credits, and unemployment data).
• Outreach and notice obligations
  • It creates ongoing notification requirements to MA enrollees about the community engagement rules and how to obtain exceptions, with phased, regular outreach starting in 2026 and continuing thereafter.
• Interaction with other programs
  • The changes interact with existing public assistance and employment programs (e.g., SNAP, the Minnesota Family Investment Program, and federal workforce programs) and reference the Workforce Investment Act framework for data exchange and program evaluation.

Implementation considerations

• Administrative burden
  • Counties and the Department of Human Services will need systems to track monthly engagement hours, manage exceptions, and process notices and redeterminations.
• Privacy and data sharing
  • The bill expands cross-agency data sharing, requiring careful adherence to privacy laws and appropriate data handling to protect individuals’ information.
• Support services
  • The bill emphasizes linking MA applicants and beneficiaries to job training, child care, transportation, and other supports to help meet engagement requirements.

Who is affected

• MA applicants and enrollees (apparent applicable individuals) who must demonstrate engagement or qualify for an exception.
• County agencies and the Department of Human Services responsible for eligibility determinations, exceptions, and notices.
• Agencies involved in data sharing and program integrity (e.g., Department of Revenue, unemployment insurance, child support, SNAP, workforce development services).

Implementation timeline highlights

• 2026: Required outreach to potentially applicable MA enrollees by Sept. 1.
• 2027 and onward: Semiannual outreach/notifications to MA enrollees about community engagement requirements.
• Ongoing: Data sharing provisions activated to support compliance, eligibility, and program evaluation.

Relevant Terms - community engagement requirements - applicable individual - Medical Assistance / MA / Medicaid - exception (for engagement requirements) - short-term hardship exception - work hours (80 hours) - community service - educational enrollment (halftime or more) - work program (as defined in federal law) - income threshold (minimum wage calculations) - seasonal worker - American Indian / Alaska Native (as defined for exceptions) - medically frail / disability considerations - data matching / electronic data sources - unemployment insurance data - wage detail data - Minnesota Statutes sections referenced (e.g., 256B.0562, 268.19, 270B.14) - outreach and notification requirements - fraud prevention and program integrity - collaboration with county agencies - SNAP / Supplemental Nutrition Assistance Program - Workforce Investment Act / employment and training - Department of Revenue data matching - Privacy and data confidentiality provisions

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