Geography: National

Request for Proposals (RFP) 

Overview 

The goal of this initiative is to develop, test, or deploy technological innovations that improve the supportive housing environment and outcomes for tenants.  

Supportive housing partners across the country are using technology in a variety of ways, including remote health monitoring, tracking program and participant outcomes, reducing isolation, improving building efficiency, and increasing safety. Technological innovations, particularly those that incorporate Artificial Intelligence (AI) are seemingly everywhere, yet without dedicated resources and intentional integration efforts, the supportive housing industry risks lagging behind in adopting tools that could meaningfully improve systems, services, and tenant experiences.  

CSH seeks to provide seed funding and/or offset staffing costs to devote to technology enhancements that would accomplish one or more of the following objectives: 

• Improve the health and wellbeing of supportive housing tenants.  

Example (illustrative only): Funding staff to explore, train on, or purchase tools that expedite claims processing through AI transcription and automated coding. 

• Enhance the tenant experience in supportive housing.  

Example: Host a tenant portal for document storage that promotes continuous eligibility in Medicaid, and/or allows tenants access to service plans, case notes, or referrals to external providers. 

• Facilitate homeless system improvements.  

Example: A Continuum of Care (CoC) requesting funding for HMIS enhancements to expedite referrals to fill supportive housing vacancies; technical assistance to support data governance policy changes that enhance technology adoption; or integration of case management software systems with HMIS to reduce duplicative data entry. 

• Optimize supportive housing organizations.  

As AI enhancements offer tools to make workflows more efficient, funds could support staff time to identify what business processes could be automated and explore tools on the market to improve business practices.    

Background 

In February, CSH convened a group of partners to identify promising practices in deploying technological innovations that improve the supportive housing environment. The convening surfaced a range of current use cases and highlighted many opportunities for further exploration.  

A summary of our Convening is linked here.  

Building on this initial inquiry, CSH is now providing small grants to organizations that will help us learn more about implementing technology and  advance the field’s adoption of helpful practices or tools. Grants are open to all supportive housing partners and will be for projects that can be completed within a roughly six-month period. 

Award Details 

Up to four applicants will be selected to receive an award ranging from $25,000 to $50,000 for a six-month period of performance. Award amounts will be determined based on proposed pilot impact, needs, and available resources. 

Eligibility  

Applicants must meet the following eligibility criteria to be considered for funding: 

• Eligible applicants include supportive housing owners, operators, or service providers; or Continuum of Care and/or HMIS lead agencies. 

• Healthcare providers may apply only in partnership with a nonprofit organization serving people in supportive housing. 

*Innovative partnerships and cross-agency collaborations are appropriate for this pilot project. Please refer to our landscape assessment (linked in the appendix) for examples of potential collaborative partnership models. 

Reporting Requirements  

CSH requires the following reporting from selected grantees: 

• A mid-project progress report identifying implementation progress, barriers encountered, and any needed course corrections. 

• A final close-out report describing project outcomes, lessons learned, and plans for sustainability or future implementation. 

CSH will provide detailed reporting guidance prior to project initiation.  

Application Components 

Applicants must submit the following materials: 

1. Project Description: Briefly describe the following aspects of the proposed project: 

1. Project title 

2. Project objective 

3. Project activities, inputs, and resources required 

4. Team’s experience with the activities proposed  

5. Project timeline 

6. Expected outcomes 

7. Sustainability plan 

2. Bios and Organizational Chart: One document containing bios for all team members involved in the pilot project. 

3. Job Descriptions: If this pilot includes a new position, please include a detailed description of the position. 

4. Letter of Commitment: A transmittal letter, signed by a person with authority to commit the organization to the proposed activities. 

5. 501(c)3 Documentation, if applicable. 

6. Completed Budget Template: Please use this template.

7. Budget Narrative  

Submission Instructions 

Submission Deadline: May 15th, 2026, at 11:59 p.m. Eastern Time.  

Applicants must submit full proposals to: 

• Kim Keaton – [email protected] 

• Katie Kitchin – [email protected]

If we receive multiple questions, CSH will publish a Frequently Asked Questions (FAQ) document. 

Selection Criteria 

Proposals will be evaluated on the following criteria: 

a. Experience and Qualifications – 35%  

• Demonstrated expertise in your selected focus area(s) and with your chosen sub-population(s), as evidenced by past relevant experience and/or industry recognition. 

• Demonstrated expertise of key personnel.  

• Understanding of supportive housing and/or homeless systems and technology. 

b. Strength of Approach – 40%  

• Detailed scope of work, objectives, and timeline.  

• Responsiveness to challenges related to technology in the homeless, supportive housing, and/or health care sectors.  

• A well-reasoned approach to the scope of work that is likely to achieve project goals and generate actionable learning.  

• Demonstrated capacity to successfully execute the proposed approach in line with the project’s goals and monitor program outcomes.  

• Ability to sustain the innovation beyond the funding provided by CSH. 

c. Budget – 25%  

• Inclusion of a detailed budget aligned with proposed activities.  

• Budget consistent with the proposed work. 

• Reasonable and appropriate staff compensation, where applicable. 

Notification of Selection and Timeline 

• RFP Open for submissions: April 22, 2026 

• Application submission deadline: May 15, 2026 

• Awards determined & applicants notified: May 31, 2026 

• Pilot period begins: June 30, 2026 

• Pilot period concludes: January 15, 2027 

Please note that CSH requires subcontractors, including individuals and sole proprietors, to carry workers’ compensation insurance and general liability insurance while performing work under a CSH subcontract. CSH subcontractors cannot have existing, pending or expired debarments that preclude them from doing business with the United States government and cannot have convictions for, nor have any pending indictments for, fraud or a criminal offense in connection with a public contract or subcontract. 

By Katie Kitchin and Kim Keaton 

Welcome to the inaugural post of the new CSH Tech Corner Series! Through this series, we will regularly share news, product features, interviews, and case studies that highlight the impact of technology on the supportive housing field. We hope you find it useful and welcome your ideas as we continue to build out this series.  

We Held an Exploratory Convening on Technology and Supportive Housing

Technological innovations, especially those powered with Artificial Intelligence (AI), are advancing so rapidly that it can be challenging for the supportive housing field to thoughtfully evaluate, test, and adopt them. While adopting new technology can be challenging, providers can use these tools to enhance the tenant experience in supportive housing and make it easier for program staff to do their work. Implementing strong data governance policies to protect both client and staff health and personal information can increase staff confidence in using these tools. 

In response to the rapid transformation of technology, CSH recently convened a couple dozen supportive housing and homeless system partners who are leaders and/or knowledgeable about the technology and software systems used in the field. These tools include Homeless Management Information Systems (HMIS) and other platforms that help with housing placement, case management, and more. From these conversations, we synthesized key learnings to share with the field.  

Top Use Cases to Consider Prioritizing

• Benefits Counseling and Activation: A common barrier to tenant employment is concern about losing disability benefits, especially health insurance. Tools that automate benefits counseling and enrollment could support continuous eligibility and help tenants pursue employment goals. This is especially important as federal support for these programs declines.  

• Digital Tools and Client-Facing Portals: There is movement toward consumer-facing digital solutions, but success depends on offering low-tech options and ensuring accessibility for populations with varying digital skills. For example, some clients do not have access to digital devices, email accounts, mobile devices, or regular internet access. 

• Documentation and Workforce Productivity: Technology-enabled documentation tools can reduce administrative burden, increase productivity, and help mitigate staff burnout. The overarching goal for implementing AI should be to alleviate administrative workloads, especially documentation. However, due to capacity issues there are challenges adoption and workflow integration.  

• Text-Based Support and Telehealth Adjuncts: Providers are increasingly using automated texting services (e.g., appointment reminders, check-ins, and support), especially for crisis intervention (such as local 24/7 call-in lines or the centralized 988 hotline). However, concerns about platform privacy and security need further consideration.  

• Automated and Streamlined Consent Processes: Automating care coordination consent, through standardized Releases of Information across partner agencies, can help bridge communication and legal barriers.  

• Client Access to Accurate Information: Ensuring clients receive precise and relevant healthcare information remains a priority, with an emphasis on solutions tailored to their specific needs. There is ongoing discussion about how tenants feel regarding the use of AI for documentation, underscoring the importance of transparency and trust. Providers should also be aware of each client’s digital usage, comfort, and literacy and incorporate organization-wide guidelines for technology adoption and change management. Not all populations are technology savvy, so providers should consider solutions that align technology literacy with innovation.   

• Data Quality Tools: AI can be used to improve data quality at the point of entry by flagging duplicates, identifying overlapping enrollments, and adding context. 

• Decision Support Tools: AI can be used for tenant matching and prioritization, as well as decision support. 

• Interoperability: Interoperable digital health platforms that securely exchange information across health, justice, and housing systems will be important for improving health and housing outcomes. 

Testing and Evaluating Emerging Digital Tools 

CSH is reviewing and evaluating a range of digital tools to better understand their impact on supportive housing. These include tools that screen, assess, and prioritize tenants for housing, as well as tools that support service documentation.  

Examples include:  

HMIS platforms that offer built-in or customizable tools for supportive housing, such as Caseworthy, ClientTrack, Bitfocus’ Clarity, and WellSky Community Services.

Housing screening tools, such as the Housing Assessment Screening Tool (HAST), inspired by a New Zealand model. 

Machine learning approaches used by Utah and Allegheny County, Pennsylvania to prioritize tenants using justice, child welfare, health, and other public system usage data. 

Case notes tools and platforms, including CARA, Elios AI, and Ambient AI for notetaking 

Leasing tools, such as Padmission, which enables grant administration, referrals and lease-up, compliance, inspection, and other operational functions.  

Further reading:  

• Why Administering Housing Programs Has Become So Difficult — and What Needs to Change 
• Why Continuums of Care Should Centralize Rental Assistance Administration 

Electronic health records for claims and service provision, as well as other digital health monitoring tools. While promising, integration, user adoption, and interoperability are still big challenges. 

Ongoing support and external funding are critical for bridging these gaps.  

Opportunities to Enhance and Improve the Built Environment Through Technology 

Technology also presents opportunities to enhance the physical and operational aspects of supportive housing: 

• HUD now allows Wi-Fi as an eligible supportive services expense if requested by an owner through the 202 PRAC program, which could open the door to designating Wi-Fi as a utility in other HUD programs. 

• Most supportive housing tenants have broadband, and in some cases, health plans provide devices for clients (phones or tablets) that support telehealth use. 

• Affordable housing developers are using AI and cameras to capture reporting information required during the construction phase.   

• Asset managers increasingly rely on precise, automated reports to track the financial performance of a building, including utility consumption, insurance claims, replacement dates, etc. 

• AI-powered leasing agents are becoming more commonly used in the sector. 

Key Issues Requiring Ongoing Attention 

• Legal and Privacy Barriers: Sharing Protected Health Information (PHI) across organizations remains a significant challenge due to varying requirements and complex release-of-information processes, especially for clients with multiple service providers.   

• Staff Concerns and Job Security: Staff have expressed fears about the use of AI, including worries about its broader impact and the possibility of job displacement. 

• Data Governance: The need for clear data governance policies came up in different contexts, such as AI use and cross-system data sharing. Partners pointed to a helpful resources from the Institute for Healthcare Improvement on AI governance.  

Where Do We Go From Here? 

Participants expressed the need for local or statewide systems to commit resources and attention to promoting adoption of technology tools that would improve the supportive housing environment—for both residents and program staff.  

The convening group also requested that CSH identify and share best practices for data and AI governance with the field.  

In response to these needs, CSH is releasing a Request for Proposals to help advance adoption and learning related to technology tools in supportive housing.  

Acknowledgements 

CSH extends its thanks to the following individuals who participated in our technology convening: 

Mike Shore and Kevin McKee, Padmission	Michelle Norris, Nsights
Jennifer Wilson, ShopWorks	Gaither Stephens, Gaither Dynamics
Thomas Garda and Courtney Battle, Housing&	Sarah Scholle, Leavitt Partners
Ryan Hertz, Lighthouse	David Lewis, Caseworthy
Lars Benson, HKS Government Performance Lab	David Eberbach, Institute for Community Alliances
Jeff Ugai, Jim Sullivan and Sarah Dougherty, Bitfocus	Brian Paul and Jennifer Disbro, Adult and Child Health
Hannah Olson and Andrea Shields, National Church Residences	Joy Moses and Nicole DuBois, NAEH
Emma Beers, The Eviction Project	Adam Ruege, Community Solutions

This framework helps hiring managers, job seekers, organization leaders, and new program planners understand the different roles in supportive housing. It highlights core skills that supportive housing staff need to be successful housing and services providers. This resource is designed to help with onboarding/mentoring staff, designing roles and programs, and identifying organization-wide training needs.

Corporation for Supportive Housing (CSH) applauds the recent federal court rulings that have upheld the integrity of the U.S. Department of Housing and Urban Development’s (HUD) Continuum of Care (CoC) homelessness funding program and reaffirmed the longstanding statutory and evidence-based foundation for supportive housing. These decisions recognize what providers, communities, and people with lived experience have long known: supportive housing is a proven, effective, and essential tool for reducing homelessness and promoting stability for people with the most complex needs.

The courts’ careful consideration of both the law and the real-world impacts of abrupt policy shifts underscores the importance of stability and predictability in homelessness systems. Sudden changes to CoC funding and program rules do not occur in a vacuum. They ripple outward, putting tenants at risk, destabilizing providers, delaying payments, disrupting services, and threatening hard-won housing outcomes. The rulings acknowledge that these harms are not theoretical, but immediate and profound.

Supportive housing works because it combines affordable housing with voluntary, flexible services tailored to people’s needs. Decades of research and practice demonstrate that this model reduces returns to homelessness, improves health and behavioral health outcomes, and lowers reliance on costly emergency systems. The model also is a cornerstone of many communities’ strategies to address chronic homelessness and prevent repeated housing instability.

While these court decisions are an important step, they do not eliminate the need for continued advocacy. Congress and the Administration play a vital role in shaping homelessness policy and funding.  It is essential that they, like the courts, are fully informed by evidence and on-the-ground experience. Policymakers must understand the effectiveness of supportive housing, the risks of destabilizing existing programs, and the harmful consequences when funding systems are thrown into uncertainty.

CSH urges providers, partners, and advocates to remain engaged, to share data, elevate lived experience, and communicate clearly about what works and why. Together, we must continue to make the case that protecting and strengthening supportive housing is not only consistent with federal law but is one of the most effective ways to reduce homelessness, promote recovery and dignity, and use public resources responsibly.

We are grateful for the leadership of providers and partners across the country and remain committed to working alongside you to ensure that supportive housing remains a central, well-supported component of our national response to homelessness.

For more than 30 years, supportive housing has transformed lives. The CSH Operations Clinic helps ensure properties continue to thrive by strengthening day-to-day operations and long-term sustainability. This one-pager describes the clinic and how it helps improve performance, stabilize operations, and better support tenants.

The CSH Supportive Housing Need tool provides communities with system‑level data on supportive housing needs across populations and systems, informing policy and program design. It also provides financial modeling at the state and local levels, allowing communities to estimate the capital, services, and operating costs to make data-driven decisions that demonstrate the effectiveness and value of sustaining supportive housing.

How States Can Design Accessible Processes to Prevent Coverage Loss for Eligible Individuals 

By Marcella Maguire, Ph.D., Director, Health Systems Integration at CSH  

As outlined in our previous post, H.R.1—the “One Big Beautiful Bill”—makes significant changes to Medicaid and creates new barriers to health insurance coverage for people who rely on the program. CSH is developing a decision tree to help your agency use every available strategy to ensure all eligible people keep their coverage as state Medicaid eligibility requirements change. Our goal remains the same: continuous healthcare coverage for everyone who qualifies under the new law. When coverage lapses and people become uninsured, they face significant challenges accessing needed health care, medications and supportive services. Losing coverage also makes it far more difficult to access treatment and maintain recovery. 

People who are covered by Medicaid solely due to low income—commonly called the “Medicaid Expansion” population—face the most significant new barriers under H.R.1. Our previous posts outlined several of these challenges, including work requirements, more frequent eligibility determinations, and new address verifications processes. This next blog focuses on one strategy states can use to help eligible individuals keep their coverage: the “Medical Frailty” designation.¹

HR1 identifies people who are “Medically Frail” as exempt from work requirements. Section 71119 (a)(9)(A)(ii)(V) defines this group a person: 

“who is medically frail or otherwise has special medical needs (as defined by the Secretary), including an individual— ‘‘(aa) who is blind or disabled (as defined in section 1614); ‘‘(bb) with a substance use disorder; ‘‘(cc) with a disabling mental disorder; ‘‘(dd) with a physical, intellectual or developmental disability that significantly impairs their ability to perform 1 or more activities of daily living; or ‘‘(ee) with a serious or complex medical condition.”² 

States must make several decisions when implementing a Medical Frailty process. CSH encourages states to make choices that limit administrative burden on enrollees and prevents eligible people from losing coverage.   

Key state decisions include: 

1. Is there a state Medical Frailty designation? 

2. If a state has chosen to make this designation, how will it define Medical Frailty? 

3. How does a person prove Medical Frailty—what documentation is required, and how long will the designation remain valid? 

DOES YOUR STATE HAVE A MEDICAL FRAILTY DESIGNATION? 

States develop their own processes to define Medical Frailty³ in more detail and determine who qualifies. For example, federal law states that a person with a “disabling mental disorder” qualifies, but states must decide whether that includes people with anxiety diagnoses, personality disorders, or Post Traumatic Stress Disorder. Many states use the Medically Frail designation to align eligibility for this group with the benefits available to people considered disabled by the Social Security Administration. States that adopt this designation use it for the many people who are in the process of applying for Supplemental Security Income (SSI) or Social Security Disability Income (SSDI).  

As of 2025, CSH is aware of 12 states that use a Medically Frail designation: Arkansas, California, Indiana, Iowa, Massachusetts, Michigan, Montana, Nevada, New Hampshire, New Jersey, North Dakota, and West Virginia.⁴   

States not on this list can create their own designation through legislation or Medicaid agency regulations. Resources such as Manatt Health’s Implementation Toolkit for States and the Medical Frailty Project Workplan can guide this process. This process includes critical feedback from People with Lived Expertise (PLE) who are current or past Medicaid beneficiaries.

HOW DOES YOUR STATE DEFINE MEDICAL FRAILTY? 

Federal law requires five broad, high-level categories of Medical Frailty. To minimize coverage loss, advocates should consider how state definitions can ensure this designation includes all eligible individuals. The required categories include people who are:⁵ 

1. Active in substance use disorder (SUD) treatment  

2. Living from a disabling mental disorder 

3. Experiencing a physical health condition or intellectual or developmental disability (IDD) that impairs ability in at least one Activity of Daily Living (ADL) 

4. Managing a serious or complex medical conditions 

5. Aged, blind or disabled as defined by the Social Security Act 

States determine how detailed or broad their definitions and documentation requirements will be. States also may choose to actively communicate about this designation and train key partners—such as hospitals, health centers, housing and homeless agencies—to ensure all who qualify will be aware and can benefit from the designation.  

HOW DOES A PERSON PROVE THEY ARE MEDICALLY FRAIL?  

States must begin to require this documentation of community engagement activities and work beginning December 31, 2026. However, advocates should know that states are actively engaging with stakeholders and planning these systems now.  

States face several decisions in this process. For example, a state’s Medicaid claims system is usually separate from its eligibility and enrollment systems. States vary in how well these separate systems communicate with each other. When data can be shared easily, information from one system can be used to confirm compliance with another system’s requirements. Some states are also integrating Medicaid data with additional systems—such as state tax systems, which verify income and work hours, or SNAP systems,⁶ which have similar work requirements.⁷   

Federal rules require states to use the ex parte process whenever possible. This means states should automatically verify eligibility using available data rather than asking individuals to submit paperwork. Under this approach, a diagnosis coded in a Medicaid claims system—such as one that meets the definition of a “disabling mental disorder”—could automatically qualify someone as Medically Frail. The individual would receive the exemption from work requirements without taking any action. 

States may also differ in the burden they place on the individual to gain this designation.  Some states may require a physician evaluation, while others allow any Licensed Practitioner of the Healing Arts (LPHA) to sign the required forms. States may or may not require an in-person interview with a state eligibility worker. The more steps and requirements in the process, the more likely eligible people will lose coverage and, consequently, access to essential services.   

States may also have a process of Application Assisters or navigators to help people complete this process. States can authorize, train, and even fund these roles. Washington State is a great example of a state that has effectively built out this role.⁸ Application assisters can access limited information in a person’s state benefits account, receive email alerts when action is needed to maintain coverage, and help upload required documents. In states with more complex Medical Frailty processes, these application assisters can be critical supports to ensure people successfully and compliantly navigating this process.

THE PATH FORWARD 

For those who quality, a Medical Frailty designation can exempt someone from work requirements and other barriers to health insurance coverage via Medicaid. Because the stakes are high, states must make thoughtful choices in designing their processes. States that prioritize continuous coverage should consider the issues outlined above. Advocates can use these ideas to influence their state’s decisions and help ensure people who are entitled to Medicaid coverage can keep it, even as H.R.1. creates new barriers.

CSH partnered with Housing Narrative Lab to research and understand supportive housing narratives. We saw a gap in supportive housing specific narrative data and sought to understand awareness and perceptions of supportive housing among broad audiences.  These research findings will help the field coordinate and rally amplifiers around messaging that resonates and persuades.

CSH estimates that there are approximately 90,000 families and youth in need of supportive housing, including 43,646 families with child welfare involvement. While lack of housing should not necessitate child welfare involvement, housing instability alongside additional challenges such as substance use or mental health needs can affect the overall placement decision. Access to permanent housing often means that families can stay together while receiving child welfare prevention services or reunify more quickly if children are in out-of-home care. Research has demonstrated that children and youth who have a reliable place to call home also spend fewer days in foster care, experience a reduction in subsequent abuse and neglect cases, reduce their risk of subsequent homelessness, and increase their school attendance.

Housing vouchers and rental assistance play a significant role in keeping families together and supporting youth in transitioning successfully into adulthood. While most housing vouchers are issued from the U.S. Department of Housing and Urban Development (HUD) via local Public Housing Authorities (PHAs) , there are many states that have funded voucher and rental assistance programs for families and transition age youth. States like New Jersey, California, Washington, and Colorado have all developed and funded housing assistance to support child-welfare involved families and youth.

UPDATED March 2026

Practical steps for states, advocates, and housing providers to prevent coverage loss 

By Marcella Maguire, Ph.D., Director, Health Systems Integration at CSH 

As we outlined in our previous post, H.R.1 (the “One Big Beautiful Bill Act”) makes significant changes to Medicaid that will require states to adapt their programs to stay in compliance.  The bill’s nearly $1 trillion reduction in federal support over 10 years will force states to cut costs, while new eligibility rules and administrative requirements are expected to push many people off Medicaid entirely. 

This article focuses on work requirements, which the federal government refers to as “community engagement.” This change will impact many affordable and supportive housing residents, people actively experiencing homelessness, people who have formerly experienced homelessness, and anyone facing any type of housing instability. 

What “Community Engagement” Means  

The Centers for Medicaid and Medicare Services (CMS), which administers Medicaid, uses “community engagement” to describe activities that will be required to keep a person’s Medicaid coverage active after 12/31/2026. A subset of Medicaid recipients will have to report 80 hours of work or other qualifying community engagement activities in the previous month to maintain coverage.  

States are already designing these systems, and those in the field participating in those discussions now can help reduce barriers that might otherwise disrupt coverage and access to supportive services. We encourage supportive housing, homelessness, and affordable housing advocates to ask their state and health care partners how they are prioritizing continuous coverage for the people they serve.  

What Research and Early State Experience Show 

Current research indicates 92% of people targeted by work requirements are already working.¹ Two states —Arkansas and Georgia —have implemented versions of these policies. Arkansas work requirements program was halted by court order in 2018-19.²  Studies found 18,000 Arkansans lost coverage, primarily because they could not navigate administrative requirements.³ Researchers found that work requirements had no positive impact on employment or health outcomes. Georgia’s program remains active and, similar to Arkansas, shows no measurable impact on work or health outcomes.⁴   

Georgia has not expanded Medicaid under the Accordable Care Act. Because there was no prior coverage pathway for many affected individuals, the state does not report comparable loss of coverage statistics.  

Despite these findings, all states must set up systems to track and ensure “community engagement” (commonly known as work requirements) by December 31, 2026. 

What This Post Covers and How Your Agency Can Prepare 

Below, we outline the critical choices states face in the coming months, who must report, who is exempt, what counts as community engagement, when requirements begin, how states will implement tracking, and concrete steps agencies can take now to help people keep coverage. 

Who Must Report Work?  

States must implement tracking systems for people whose Medicaid eligibility is based solely on low income—often called the expansion population—in states that expanded Medicaid. Non-expansion states are not required to create these systems, although some, such as Georgia, are experimenting with the impact of these programs.⁵⁶ 

This same group will also face more frequent eligibility redeterminations. Proof of work or community engagement will be required at application and at each redetermination. States are required to look back at least one month and up to three months before application within each six-month eligibility period to verify compliance. 

Whose Exempt from Work Requirements? 

States have some flexibility to set exemptions, and federal law requests several. As defined by the law, exemptions must include:⁷ 

1. People under age 19 or 65 and older 

2. American Indians and Alaska Natives 

3. Caregivers for children 13 or younger 

4. Veterans with disabilities 

5. People enrolled in substance use disorder treatment 

6. People deemed medically frail (states must define and operationalize this process).⁸  

7. People facing a short‑term hardship (for example, some states are considering homelessness as a short‑term hardship; Montana has requested this, and as of February 25, 2026, no public decision has been posted).⁹  

8. People living in an area with a Presidential disaster declaration¹⁰ 

9. People in an area with unemployment at or above 1.5 times the national rate 

What Constitutes Work or Community Engagement Under H.R.1? 

H.R.1 (Public Law 119-21) ties continued Medicaid eligibility to completing least 80 hours per month of qualifying work and community engagement activities. States have some discretion to refine categories and set tracking methods. Allowable categories include: 

1. Employment: Any paid job counts toward the 80‑hour requirement 

2. Job training/workforce development: Job skills training, workforce preparation, or structured employment programs qualify 

3. Education: Enrollment at half time or more in an approved program, including adult education, community or technical college, GED coursework, or higher education 

4. Community service: Unpaid service with nonprofits, civic, or community organizations that add up to 80 hours 

CSH launched a new partnership to pilot Clubhouse participation to enhance recovery and advocates for other supported employment opportunities to count as work. In states that fund these services through Medicaid, agencies should be able to track attendance via Medicaid claims, so individuals don’t need to submit extra paperwork.  

States are also modernizing data systems. If eligibility systems for Medicaid and SNAP communicate, compliance documented in one program could automatically satisfy requirements in the other, reducing the burden on individuals. The simpler and more automated the system, the fewer eligible people will lose coverage due to paperwork barriers. 

When Do the Requirements Start? 

States must have systems operational by December 31, 2026, to comply with H.R.1 and we expect states to roll out requirements in fall 2026.  

To meet federal minimums, states must verify at least 80 hours of work or community engagement in the month before a person applies or redetermines coverage. “Redetermination” means the state confirms the person still qualifies for Medicaid, typically every six months for this population. States may choose to check more often, but federal rules don’t require it.  

How Will States Track and Verify? 

States must quickly develop ways to track compliance and exemptions and should prioritize verification that doesn’t burden people. Examples include: 

• Data matching with state wage or tax systems to verify work without extra paperwork. 

• Claims‑based verification for participation in Medicaid‑funded services (e.g., supported employment). 

• Interoperability with SNAP or other programs to reduce duplicate reporting. 

Today, many state databases operate in silos—even within Medicaid (eligibility vs. claims) and across agencies (e.g., tax, workforce). States that already link systems to comply with SNAP work reporting can apply those lessons to Medicaid. 

States must check compliance at least every six months, including at application and each redetermination. Communication channels vary widely: most states accept documents online; a few still require in‑person interviews. Some allow trained assisters or navigators to support people directly in their online accounts. Clear, proactive communication will be essential, so case managers, service coordinators, peer supports, and housing staff can help people maintain coverage. 

What a state will count as proving compliance remains to be determined, and advocates are encouraged to push states to make these systems as easy to navigate as possible.  

How to Maintain Coverage Under the New Rules 

Confirm expansion status. Determine whether you—or your tenant/resident—are in the expansion group (income‑only eligibility). Check state eligibility criteria, contact your Medicaid office, or review enrollment notices and codes that indicate expansion coverage. 

Assess eligibility for traditional Medicaid. If someone may qualify through disability (via the Social Security Administration), consider starting that process now. It can be lengthy, and disability advocacy is often critical to success. 

Check for exemptions. Review the exemption list above. If one applies, gather documentation early and note how the state wants it submitted.  

Plan for compliance if needed. If a person is in the expansion group, does not qualify for traditional Medicaid, and does not meet an exemption, help them identify qualifying activities and straightforward ways to document 80 hours per month. 

Helpful Resources 

CSH’s partner agencies also have released helpful material regarding this issue, including: 

• National Health Law Program, Justice in Aging, and Bazelon Center for Mental Health Law 

• Center on Budget and Policy Priorities 

• National Health Care for the Homeless Council (NHCHC) 

Bottom Line 

Our shared goal is to help people maintain continuous health insurance coverage, so they can access the services necessary to manage health conditions and thrive in their communities. Agencies, staff and advocates should be engaging with state officials now to make the systems as easy to navigate as possible. Providing support as people adjust to these requirements will help them stay connected to essential services and strengthen their ability to remain stably housed.