14. Department of Health and Human Services · Notable
Let states redesign Medicaid benefits without waivers
Printed page 468 14. Department of Health and Human Services
“Increase flexible benefit redesign without waivers. CMS should add flexibility to eliminate obsolete mandatory and optional benefit requirements and, for able-bodied recipients, eliminate benefit mandates that exceed those in the private market.”
What has happened
- Not started
The mandatory and optional benefit structure of 42 CFR part 440 is unchanged, and no rulemaking of the window loosens benefit requirements for able-bodied adults or lets States redesign long-term care outside a waiver. The Medicaid rulemaking that did happen restricts benefits for a named service rather than devolving benefit design: the sex-rejecting-procedures funding prohibition (proposed 2025-12-19, final 2026-08-13). Public Law 119-21 § 71121 adjusts home and community-based services, and § 71118 makes demonstrations harder to approve, not easier to avoid. Negative search recorded in `docs/research/ch-14.md` under the round-2 (ticket 16) cluster searches.
No action found yet. This entry is the starting point, not a finding.
Research log
What was searched, and what didn’t count as evidence
Research notes
- Searched: every Medicaid rule and proposed rule of the window among the federal records we keep and search (30 records), read by title; the Federal Register since 2025-01-20 for “benefit mandates” → 2 (both the 2027 Payment Notice, on ACA essential health benefits, not Medicaid); “state plan amendment” → 10 documents, none a benefit-flexibility rule.
- #1312 (one of the most significant asks) owns the sex-rejecting-procedures rules; they are named here only to show what the Medicaid benefit rulemaking of the window actually was.
- Unified Agenda, checked 2026-09-01. Checked against the full HHS agenda on
reginfo.gov (183 active RINs in the 2026 Unified Agenda, published
2026-08-14), not the abbreviated version the Federal Register prints. The nearest entries are
recorded here; neither names this ask’s object, so the Status is unchanged: an agenda entry,
like a strategic plan, counts only when it names what the ask asks for.
- Two entries sit near this ask and neither reaches it. 0938-AW02 (RFI: Comprehensive Review of the Essential Health Benefits Framework and Typical Employer Standard, CMS-9874, RFI 07/2026) reopens what a commercial benchmark plan must cover, not Medicaid’s mandatory and optional benefits at 42 CFR part 440. 0938-AW06 (Strengthening the Integrity of Section 1115 Demonstrations, CMS-2412, NPRM 01/2027) adds a § 1115 requirement rather than removing the need for a waiver.
- Action
- eliminate
- Object
- Medicaid benefit mandates
- ID
- 1285