The Centers for Medicare & Medicaid Services today issued policy guidance for states proposing demonstration projects that require or encourage working-aged Medicaid beneficiaries who are not pregnant or disabled to participate in work or other “community engagement” activities, such as training or volunteer services. “Some states are interested in pursuing demonstration projects to test the hypothesis that requiring work or community engagement as a condition of eligibility, as a condition of coverage, as a condition of receiving additional or enhanced benefits, or as a condition of paying reduced premiums or cost sharing, will result in more beneficiaries being employed or engaging in other productive community engagement, thus producing improved health and well-being,” the guidance states. “To determine whether this approach works as expected, states will need to link these community engagement requirements to those outcomes and ultimately assess the effectiveness of the demonstration in furthering the health and wellness objectives of the Medicaid program." According to CMS, 10 states to date have submitted proposals that include employment and community engagement initiatives: Arizona, Arkansas, Indiana, Kansas, Kentucky, Maine, New Hampshire, North Carolina, Utah and Wisconsin. For more on the policy guidance, visit