Operationalizing the Medical Frailty Exemption: A Step-by-Step Implementation Toolkit for States

Support for this toolkit was provided by the State Health and Value Strategies program, a grantee of the Robert Wood Johnson Foundation. The views expressed here do not necessarily reflect the views of the Foundation.

The enactment of H.R.1 introduces mandatory work reporting requirements for Medicaid expansion adults, while explicitly exempting individuals who are medically frail. The statute further requires states to attempt to verify medical frailty exemptions ex parte—using data already available to the state, where possible, without requiring information from individuals. These requirements present significant . States must align clinical definitions, programmatic eligibility, data architecture, and information technology systems to ensure that the most at-risk individuals can enroll in and maintain coverage. 

In this toolkit, prepared for the Robert Wood Johnson Foundation’s State Health and Value Strategies program, Manatt Health Partner , Senior Managing Director and Senior Managing Director provide a step-by-step guide for how states can tackle the operationalization of medical frailty exemptions, while reducing burden on individuals and state administration and making accurate eligibility determinations.

To view the full toolkit, click