The Centers for Medicare & Medicaid Services today approved a Section 1115 demonstration waiver for Arkansas that will require some adult beneficiaries under age 50 to work or participate in job training, community service or other “community engagement” activities at least 80 hours per month to remain eligible for Medicaid coverage. The waiver amends and extends through 2021 the Arkansas Works program, which provides certain adult beneficiaries with premium assistance to purchase qualified health plan coverage through the Health Insurance Marketplace. CMS in January 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, later approving waivers for Kentucky and Indiana. At least seven other states have submitted proposals that include community engagement initiatives: Arizona, Maine, Michigan, Mississippi, North Carolina, Utah and Wisconsin.