From DC is Justice in Aging's weekly roundup of national news and resources about issues impacting older adults. To receive From DC in your inbox as soon as its published, sign up for our mailing list.
Here’s what we’re watching in Washington:
Updates on “Medically Frail” Exclusion for Medicaid Work Requirements
The Centers for Medicare and Medicaid Services (CMS) released a slide deck with new guidance explaining how states should implement the “medically frail” exclusion under Medicaid’s community engagement requirements (also known as work requirements).
The slide deck reiterates the additional restriction from the Interim Final Rule (IFR) that individuals must show that their health condition significantly limits their ability to meet community engagement requirements. It outlines a tiered system for applying diagnostic codes to determine whether a condition meets medically frail criteria and provides examples of qualifying conditions.
As Justice in Aging stated in our IFR comments, the rule greatly narrows the medically frail exclusion beyond what the statute requires, creating substantial burdens for older adults and states. These restrictions also make it harder for people with delayed diagnoses, fluctuating conditions, or hard‑to‑diagnose illnesses to be excluded from work requirements.
Justice in Aging recently joined a group of 70 organizations led by the National Health Law Program that filed an amicus brief in Massachusetts v. Oz, a case challenging the community engagement IFR. The amicus brief supports the plaintiff states’ argument that the IFR unlawfully narrows the exemption Congress created for people who are medically frail or have special medical needs. It also details how the rule will strip health coverage from people with serious illnesses and disabilities, many of whom are older adults.
Justice in Aging is monitoring state implementation of community engagement requirements. For more resources, see our webinar on Understanding New Medicaid Work Requirements and our advocacy toolkit.
New HUD Fair Housing Guidance on Accessibility Cases
The Department of Housing and Urban Development (HUD) recently issued new guidance limiting the deadline to file administrative fair housing complaints based on violations of the Fair Housing Act’s design and construction standards. These design and construction standards, which apply to multifamily buildings built after March 1991, require properties to meet a minimum level of physical accessibility for people with disabilities.
HUD’s new guidance states that HUD will no longer accept design and construction complaints filed beyond one year after a covered property completes construction. Previously, HUD interpreted the Fair Housing Act to allow these complaints to be filed at any time a covered building continues to be in noncompliance. HUD’s guidance itself, however, does not change the law around deadlines for filing design and construction lawsuits in court.
For more information on the Fair Housing Act, including issues related to accessible housing, see Justice in Aging’s webinar on Federal Fair Housing Basics.
Lawsuits Challenge New Public Charge Rule
On Monday, a coalition of state Attorneys General, led by New York, filed a lawsuit in the U.S. District Court for the Southern District of New York challenging the implementation of the new public charge rule. On the same day, a coalition of local governments also filed a lawsuit challenging the rule.
The new public charge rule promulgated by the Department of Homeland Security (DHS) and its accompanying guidance will be effective on Friday, September 18. This rule rescinds longstanding policy regarding immigrants who are seeking to adjust their status to lawful permanent residency (LPR)—i.e., those applying for a green card—making the process more difficult for individuals who use government benefits.
The new rule also gives immigration officers abundant discretion in making decisions about applicants seeking LPR and removes the meaningful guidelines that immigrants and their advocates have relied on for decades. In opposing this rule, Justice in Aging and other advocates warned DHS about a “chilling effect” that will diminish the use of critical public benefits among all people in immigrant communities due to increased fear and confusion about the new rule.
The lawsuits filed by states and local governments cite DHS’s failure to engage in the reasoned decision-making process required by the Administrative Procedure Act (APA) and explain the negative impacts this rule will have on state budgets and constituents. The states and local governments ask the court to declare that the new public charge rule exceeds DHS’s authority and violates the APA.
Learn more about the new public charge rule in Justice in Aging’s webinar, Public Charge Final Rule: What Advocates Need to Know
Reports Highlight Dual Eligible Population
In July, the CMS Medicare-Medicaid Coordination Office (MMCO) released its annual report to Congress for fiscal year 2025. This report highlights key characteristics of the 12.5 million individuals dually enrolled in Medicare and Medicaid. More than two-thirds are age 65+ and 72% are eligible for full Medicaid benefits (“full benefit duals”), while 28% only receive help with Medicare cost sharing (“partial benefit duals”). Among full benefit duals, 63% have three or more chronic conditions, and 64% have a behavioral health diagnosis. Over 70% of Medicaid enrollees that use LTSS are dually eligible.
The MMCO report also discusses increasing enrollment in Dual Eligible Special Needs Plans, as well as updates to Medicare Savings Programs and state payment of Medicare premiums through the buy-in process.
The MedPAC July 2026 Data Book also discusses characteristics of dually eligible individuals. The data shows that 59% of full benefit duals and 78% of partial benefit duals are enrolled in a Medicare Advantage plan, compared to 51% of non-dually eligible Medicare enrollees.
Learn about Justice in Aging’s advocacy to improve access to care for people dually eligible for Medicare and Medicaid.
