Federal officials have shown states how they could use medical claims and other data to decide which Medicaid enrollees are too sick to meet new work requirements, a step that may determine whether many people with chronic illness need to submit paperwork to keep their coverage. The Centers for Medicare & Medicaid Services released an example three-tier framework for the "medically frail" exemption on Sept. 8.
Under the model, some diagnoses in a person's claims history could qualify them on their own. Others would need supporting data, such as pharmacy records or medical equipment claims. People whose records do not settle the question would face an individual review that could require medical documentation.
