State Medicaid agencies have fresh instructions from the HHS Office for Civil Rights on using addiction treatment records to decide who qualifies for an exemption from the program’s community engagement mandate.
Most Medicaid enrollees between 19 and 64 must log 80 hours a month of work, volunteering, or similar activity, or carry at least a half-time school load, to stay eligible. People with special medical needs – a category that can take in those with a substance use disorder or those receiving treatment – can be excused.
At issue is 42 CFR Part 2, the long-standing federal shield for addiction treatment files. Federal law tells states to lean on reliable information they already hold instead of demanding fresh paperwork from applicants, and the new note explains how that duty squares with the rule’s consent requirements.
CMS collaborated with OCR on the guidance. “This OCR guidance will help state Medicaid agencies use information they already have to identify individuals who are excluded from the community engagement requirement, while continuing to protect the confidentiality of SUD patient records as required by Part 2,” OCR Director Paula M. Stannard said.
The takeaway for compliance staff: Part 2’s consent restrictions can surface during eligibility work, well away from a treatment room.
