KRS 205.5371: Demonstrated community engagement -- Definitions for section.

(1) (a) The cabinet shall, no later than January 1, 2027, for applicable individuals as

defined in 42 U.S.C. sec. 1396a(xx)(9), condition eligibility for enrollment or

continued enrollment in the Medicaid program on demonstrated community

engagement as defined in and required under 42 U.S.C. sec. 1396a(xx).

(b) In the case of an applicable individual who is applying for enrollment in the

Medicaid program, in order to be eligible for enrollment the individual shall

be required to demonstrate community engagement for the month

immediately preceding the month during which the individual applies for

enrollment.

(c) In the case of an applicable individual who is enrolled and receiving Medicaid

benefits, in order to remain eligible for continued enrollment, at the time of

eligibility redetermination, the individual shall be required to demonstrate

community engagement for three (3) months during the period of time since

the individual's most recent eligibility determination or redetermination.

(2) Notwithstanding any provision of state law to the contrary, the cabinet shall not

request an exemption, waiver, or any other delay, including but not limited to a

good-faith-effort exemption, in implementing the requirements of 42 U.S.C. sec.

1396a(xx) or subsection (1) of this section that may be available to the state under

42 U.S.C. sec. 1396a(xx)(11) unless specifically authorized by the General

Assembly to do so.

(3) The cabinet shall begin, no later than September 1, 2026, providing notice to all

applicable individuals, as defined in 42 U.S.C. sec. 1396a(xx)(9), of the

requirement to demonstrate community engagement as established under 42 U.S.C.

sec. 1396a(xx) and subsection (1) of this sec tion. Notice provided under this

subsection shall comply with the requirements of 42 U.S.C. sec. 1396a(xx)(8).

(4) If at any time on or after April 14, 2026, the federal community engagement

requirements established in 42 U.S.C. sec. 1396a(xx) are abolishe d, repealed, or

otherwise diminished, the cabinet shall:

(a) Immediately prepare and submit a waiver application to the federal Centers

for Medicare and Medicaid Services seeking authorization to condition the

eligibility of applicable individuals, as defi ned in subsection (5) of this

section, to enroll or continue to be enrolled in the Medicaid program on

demonstrated community engagement, as defined in subsection (5) of this

section; and

(b) For applicable individuals, as defined in subsection (5) of this section, and in

accordance with subsection (1)(b) and (c) of this section, condition eligibility

for enrollment or continued enrollment in the Medicaid program on

demonstrated community engagement, as defined in subsection (5) of this

section, if authoriz ed to do so by the federal Centers for Medicare and

Medicaid Services.

(5) As used in subsection (4) of this section:

(a) "Applicable individual" means an individual who is:

1. At least nineteen (19) years of age but less than sixty -five (65) years of

age;

2. Eligible for enrollment or currently enrolled in the Medicaid program

under 42 U.S.C. sec. 1396a(a)(10)(A)(i)(VIII) or a waiver that provides

coverage that is equivalent to minimum essential coverage as described

in Section 5000A(f)(1)(A) of the Internal Revenue Code of 1986; and

3. Not:

a. Currently, or was not previously, placed in the foster care system

if the individual is under twenty-six (26) years of age;

b. Eligible for coverage under the Indian Health Service;

c. A parent, guardian, caretaker relative, or family caregiver, as

defined in the RAISE Family Caregivers Act, Pub. L. No. 115 -

119, of a dependent child thirteen (13) years of age or under or a

disabled individual;

d. A disabled veteran with a disability rated as total under 38 U.S.C.

sec. 1155;

e. Medically frail or otherwise has special medical needs, including

an individual:

i. Who is blind or disabled;

ii. With a substance use disorder;

iii. With a disabling mental condition;

iv. With a physical, intellectual, or developmental disability that

significantly impairs his or her ability to perform one (1) or

more activities of daily living; or

v. With a serious or complex medical condition;

f. An individual subjec t to work or community engagement

requirements imposed under the Supplemental Nutrition

Assistance Program or Temporary Assistance for Needy Families,

if the individual is in compliance with such requirements;

g. An individual participating in a drug addiction or alcohol addiction

recovery program recognized by the secretary through the

promulgation of administrative regulations in accordance with

KRS Chapter 13A;

h. An inmate at a public institution;

i. Pregnant or eligible for coverage under KRS 205.592; or

j. An individual experiencing a short-term hardship as defined by the

secretary through the promulgation of administrative regulations in

accordance with KRS Chapter 13A; and

(b) "Demonstrated community engagement" means satisfying one (1) or more of

the following conditions on a monthly basis:

1. Working, as defined in 7 C.F.R. sec. 273.24, not less than eighty (80)

hours;

2. Completing not less than eighty (80) hours of community service;

3. Participating in a work program, as defined in 7 C.F.R. sec. 273.24, for

not less than eighty (80) hours;

4. Participating at least half -time in an education program recognized by

the secretary through the promulgation of administrative regulations in

accordance with KRS Chapter 13A;

5. Engaging in any combination of activities described in subparagraphs 1.,

2., 3., and 4. of this paragraph for a total of not less than eighty (80)

hours;

6. Having a verifiable monthly income that is not less than applicable state

minimum wage established in KRS 337.275 multiplied by eighty (80)

hours; or

7. Having a verifiable average monthly income over the previous six (6)

months that is not less than applicable state minimum wage established

in KRS 337.275 multiplied by eighty (80) hours if the individu al is a

seasonal worker as described in Section 45R(d)(5)(B) of the Internal

Revenue Code of 1986.