The reality of Medicaid work rules has been setting in, from CMS releasing its implementation framework to health system CEOs modeling the fallout.
HR 1 established community engagement requirements for low-income, nonpregnant people between ages 19 and 64, which are slated to go into effect in 2027. While states are unable to contract with Medicaid managed care organizations for verification of beneficiary compliance, some plans are taking steps to ensure continued coverage — including helping out with beneficiaries’ job hunts.
On June 16, Managed Health Services, a Centene managed care organization, shared its “MHS Serves Workforce Support Program.” The initiative stems from MHS Serves, which focuses on social drivers of health in Indiana.
The program will issue grants to Indiana nonprofits that support workforce development. One type of grant ranges from $50,000 to $150,000 and is specifically for community-based organizations offering direct employment services and training. The other tier, which ranges from $300,000 to $500,000, will be allocated to regional organizations for strengthening referrals, aligning training with employer needs and monitoring outcomes. Applications are open through June 19.
Centene has also leaned into this kind of work with subsidiary Iowa Total Care, which launched an Empowerment Command Center in Ottumwa in October 2025. In partnership with Central Iowa Shelter & Services, the Medicaid plan and Centene’s philanthropic arm are helping with case management, housing pathways and health access — as well as job training. Under the Medicaid work rules, job training can count toward the community engagement requirement.
Aetna also just announced a $1.2 million investment in its home state of Connecticut for academic programs and career development.
On an upcoming episode of the “Becker’s Payer Issues Podcast,” Independence Health Group President and CEO Kelly Munson said, while many people may already fulfill the work requirements and just need to make sure they are accounted for, she is actively thinking about supporting those seeking opportunities. Through an economic sustainability program, Ms. Munson’s team aims to help with job, education and volunteering placements. Other considerations include interview guidance for those transitioning from being incarcerated, resume support and access to professional clothing. Ms. Munson said the company is collaborating with workforce boards, as well.
“Not a lot of people are real into their mail anymore, so, it’s like, do people know and understand this change is coming, and how do we avoid them dropping off?” she said.
Independence Health Group, which owns Independence Blue Cross and has joint ownership of AmeriHealth Caritas, also developed an app to store members’ work information that can then be shared with states.
These kinds of efforts aren’t entirely new, and some predate HR 1. In early 2025, Aetna Better Health of Illinois and its parent, CVS Health, said they were issuing $750,000 in community grants to organizations in the state, which included contributions to workforce development and educational opportunities. Aetna has made similar contributions over the years across states, as well. In May 2025, Iowa Total Care established an Empowerment Command Center in Grinnell, also part of the two-year, $2.55 million commitment that spurred the Ottumwa site. But the upcoming work requirements are only adding fuel to the fire.
“The new workforce initiative comes as MHS prepares for new eligibility and enrollment changes to the Medicaid program established under HR 1, including requiring certain adults to meet new work or community engagement standards,” the MHS news release said. “Working hand-in-hand with state and county partners, MHS will provide clear, timely guidance to its members and providers as this new policy takes shape.”
Managed care capitation payments have become a larger share of Medicaid benefit spending in recent years, according to the Medicaid and CHIP Payment and Access Commission. As work requirements take effect, the pressure to retain enrollees is mounting, and costs across the healthcare landscape could be on the line if the uninsured population grows.
“The most important thing we could possibly do is assure that people [who] should be covered are covered because they deserve that, and because it’s going to keep the cost in the healthcare system lower,” Ms. Munson said.
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