Dear Administrator Oz:
New Jersey Policy Perspective (NJPP) appreciates the opportunity to comment on the Centers for Medicare & Medicaid Services’ (CMS) Interim Final Rule implementing Medicaid community engagement requirements under H.R. 1.
Specifically, NJPP urges CMS to broaden its definition of medical frailty and preserve states’ ability to rely on self-attestation when verifying it.
NJPP is a nonpartisan, nonprofit organization that drives policy change to advance economic, social, and racial justice for New Jersey residents. Through independent research, analysis, and advocacy, NJPP works to ensure that state and federal policies expand opportunity and promote the well-being of all New Jerseyans.
NJ FamilyCare, New Jersey’s Medicaid program, is the foundation of the state’s health care safety net and provides health coverage to more than 1.8 million New Jersey residents, including 305,000 enrolled in NJ FamilyCare’s Aged, Blind, Disabled (ABD) program.[1] For these residents, Medicaid is more than health insurance, it pays for the daily services and supports they need to live safely and with dignity, whether in their own homes, community-based settings, or nursing facilities.
Although Congress exempted medically frail individuals from community engagement requirements, the interim final rule goes beyond the scope of H.R. 1 by adopting policies that make those exemptions more difficult to access and administer. New Jersey’s experience during Medicaid unwinding demonstrated that increased paperwork and verification requirements can cause eligible people to lose coverage. The interim final rule risks repeating those mistakes by adopting an overly restrictive approach to medical frailty and limiting states’ ability to rely on self-attestation. As CMS implements H.R. 1, we urge the agency to prioritize policies that preserve coverage for individuals who remain eligible for Medicaid while minimizing unnecessary administrative burden on beneficiaries, providers, and state Medicaid agencies.
CMS Should Adopt a Broader and More Practical Definition of Medical Frailty
The interim final rule requires states to determine not only that an individual has a qualifying medical condition, but also that the condition significantly impairs the person’s ability to participate in community engagement activities. While New Jersey intended to rely primarily on existing administrative and claims data to identify individuals who qualify for the medical frailty exemption, this additional requirement will instead require many beneficiaries to obtain medical documentation from their health care providers to demonstrate the extent of their functional limitations.
Obtaining this documentation will be difficult for many New Jersey residents living with cancer, serious mental illness or substance use disorder, or other chronic conditions. At the same time, physicians and other clinicians, who are already facing workforce shortages and considerable administrative demands, will be asked to complete forms and certify functional impairment, diverting time away from patient care.
CMS should eliminate the requirement that medically frail individuals demonstrate significant impairment and allow states to rely on available administrative data, supplemented by clinical information when needed, to identify individuals who qualify for the medical frailty exemption. This approach would better protect eligible beneficiaries and reduce unnecessary burdens on providers. It would also let states implement the exemption in a way that reflects the realities of people living with complex medical conditions.
States Should Retain Flexibility to Use Self-Attestation
NJPP is also concerned that the interim final rule unnecessarily limits the use of self-attestation when determining medical frailty.
Medicaid has always worked to balance program integrity with administrative efficiency by allowing states to accept self-attested information when electronic verification is unavailable or impracticable. Restricting self-attestation shifts unnecessary administrative burden onto beneficiaries with serious health conditions, many of whom face obstacles to obtaining repeated medical documentation.
These requirements also increase administrative costs for states and providers without improving oversight or accuracy. New Jersey has invested significantly in streamlining eligibility processes and maximizing automated verification. CMS should allow states to continually accept self-attestation for medical frailty exemptions, particularly when reliable administrative data or other verification sources are unavailable, so that individuals with serious health needs are not disenrolled from Medicaid simply because they are unable to navigate burdensome documentation requirements.
Conclusion
Administrative complexity should not become a barrier to health coverage for people who remain eligible for Medicaid. The interim final rule should support efficient administration while protecting medically frail individuals from unnecessary coverage loss.
NJPP respectfully urges CMS to:
- Adopt a broader and more workable definition of medical frailty.
- Preserve state flexibility to use self-attestation when electronic verification is unavailable.
- Reduce unnecessary documentation requirements that increase administrative burden without improving program integrity.
Thank you for the opportunity to submit these comments. We appreciate CMS’s consideration and urge the agency to revise the interim final rule to ensure that implementation protects access to health coverage, minimizes unnecessary administrative burden, and allows states like New Jersey to administer Medicaid efficiently while preserving coverage for eligible residents.
End Notes
[1] New Jersey Department of Human Services. Division of Medical Assistance and Health Services June 2026 Enrollment Report. June 2026.
