A technical mismatch sits at the center of the Medicaid medical frailty exemption, and it will help decide whether seriously ill adults keep their coverage automatically or have to prove their limitations by hand.
Federal rules require states to check claims and encounter data from the preceding 12 months before asking an enrollee for anything. But the standard those records must satisfy is functional. Under the interim final rule, states must consider not only whether a person falls into one of the five statutory frailty categories, but also whether the condition significantly impairs the ability to meet the community engagement requirement. A diagnosis alone is not enough.
