ACA Survey: Medicaid Eligibility and Redetermination

Background: Implementation of the H.R.1 (also referred to as the One Big Beautiful Bill Act or Working Family Tax Cut Legislation) is January 1, 2027. American Indian/Alaska Natives (AI/AN) and certain individuals eligible to receive care from the Indian Health Service (IHS) are exempt from community engagement, 6-month eligibility redetermination and new cost-sharing requirements included in H.R.1.

The Tribal Technical Advisory Group (TTAG) has been working with the Centers for Medicare and Medicaid (CMS) to issue Tribal guidance on the new requirements. The CMS Tribal guidance is intended to assist States to implement the Tribal exemptions in an effective way so that the process is not burdensome or invasive for beneficiaries.

Request for Information: To assist in this effort, the Tribal Self-Governance Advisory Committee (TSGAC) under the National Indian Health Outreach and Education Project is seeking your input on both current issues and barriers you are encountering with Medicaid applications and eligibility and the steps your state is taking to consult with Tribes and to implement the provisions of the H.R. 1.

Information gathered under this survey will be shared with the CMS TTAG and will greatly assist in understanding current Tribal experiences in working with your respective States on these Medicaid redeterminations.

Thank you in advance for taking the time to provide us with your input!

Name

First NameLast Name

Tribal/Organization

State

Email

example@example.com

Please check here if we can use your Tribe by name in the survey results. Tribes will not be identified by name, unless explicitly authorized.

1) What is your role in your Tribal health program?

1a. Other - Please List Title

2) In your role, are you actively involved in State Medicaid meetings?

3) Are you aware of the AI/AN exemptions?

4) On a scale of 0-10 please note how familiar you are with the new H.R.1 Medicaid changes for community engagement, 6-month redetermination, and expanded cost-sharing requirements?

Not Familiar at all - Somewhat Familiar - Moderately Familiar - Very Familiar - Extremely Familiar

5) Are you encountering any barriers with getting Medicaid eligibility inplace for new applications or redeterminations/renewals? (Check Yes or No)

If yes, please share what are the issues?

6) Are you encountering delays or is eligibility pending on applications where the Tribal member may have had an old documentation request that they did not respond to or supply the requested information? (Check Yes or No)

If yes, please share what are the issues?

7) How and when does your State Medicaid Agency collect information on AI/AN status?(e.g. at enrollment through Self-attestation, claim history, document verification, etc.)

8) Has your State Medicaid Agency communicated with your I/T/U regarding the new H.R. 1, requirements that will go into effect January 1, 2027? If yes, please share.

9) Has your State Medicaid Agency indicated they plan to implement community engagement/work requirements ahead of the January 1, 2027, deadline?

9a. Has your state indicated whether they will accept “self-attestation” to verify eligibility for I/T/U services?

9b. If they will not, can you explain what the State’s plan is to verify eligibility for I/T/U services:

10) State Medicaid agencies are required to conduct beneficiary outreach on these new requirements between June 30 and August 31, 2026. Has your State Medicaid agency shared its education and outreach plan with Tribes?

10a. If so, can you check all that apply:

11) Did your state share data with your I/T/U during the Public Health Emergency (PHE) Unwinding and if so, was it helpful?

12) What would you like to see included in data sharing requests with the State Medicaid Agency?

13) What other general information or comments would you like to share with us regarding your recent experiences?

For additional help on specific questions, please refer to our Ask A Question form, located here. Thank you so much for your responses; we truly appreciate your insight and time!

Medicaid Eligibility and Redetermination Survey