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States can now sort Medicaid recipients into health-severity tiers when deciding who is too ill to work or volunteer, under guidance released this week by the Centers for Medicare and Medicaid Services.
Medical frailty, in plain terms, is the official Medicaid designation for enrollees whose health prevents them from meeting a participation requirement, and the new guidance gives states a defined way to evaluate those cases by degree of illness rather than forcing a single yes-or-no call.
Patient advocacy groups and some medical associations described the change as a small relief, after criticism that the medical frailty exemption process was confusing for patients and burdensome for providers.
What the tier system changes The threshold this guidance applies to is 20 hours per week of work or volunteer activity.
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