Keeping Disabled Clients Covered Under the New Medicaid Work Requirement

Leonardo Cuello, J.D., Research Professor | Georgetown University McCourt School of Public Policy

Leonardo Cuello is a Research Professor at the Georgetown University McCourt School of Public Policy’s Center for Children and Families, where his work centers on Medicaid law and policy — Medicaid and Marketplace waiver authority, Medicaid managed care, Medicaid expansion, benefit packages, payment and delivery system reform, and health-related social needs. Across two decades in the field he has been involved in many of the major Medicaid issues and litigation of recent times, work requirements among them.

• Education & Credentials

He earned his J.D. from the University of Pennsylvania Law School and his B.A. from Swarthmore College.

• Recognition & Leadership

He holds a research professorship at the Center for Children and Families, a health policy and research center at the McCourt School of Public Policy. Immediately before joining the Center he served as Health Policy Director at the National Health Law Program, directing that organization’s health policy work.

• Professional Involvement

A stated aim of his current work is the development of accessible, bilingual educational resources, in English and Spanish, for advocates, policymakers, and the public. Earlier in his career he ran an immigrant and Latino healthcare project, work that placed Medicaid eligibility and services questions in front of him daily.

• Experience

His Medicaid practice spans two decades and reaches the eligibility and coverage questions the community engagement requirement now unsettles: waiver authority under both Medicaid and the Marketplace, Medicaid managed care, expansion, benefit package design, and payment and delivery system reform. He has been involved in many of the major issues and litigation of recent times, including work requirements. Before his policy directorship, he spent six years on staff at the Pennsylvania Health Law Project, where he provided direct representation to low-income immigrants and Latinos and worked on Medicaid eligibility and services issues — the client-level view of the same rules this program addresses.

Kevin J. Malone, Member of the Firm | Epstein Becker & Green, P.C

Kevin J. Malone is a Member of the Firm at Epstein Becker & Green, P.C. in Washington, DC, and a Strategic Advisor with EBG Advisors. He led the federal implementation of the 2013 Alternative Benefit Plan rollout at CMCS — the framework from which the medically frail standard descends — and his practice today covers health policy and legislation, managed care, behavioral health, mental health parity, and government and commercial coding, coverage, and payment for health plans, provider organizations, states, and trade associations.

• Education & Credentials

He earned his J.D. from The George Washington University Law School and his B.A. from Washington University in St. Louis. He is admitted to practice in the District of Columbia, Massachusetts, and New York.

• Recognition & Leadership

He has been recognized in The Best Lawyers in America© “Ones to Watch” in Health Care Law from 2022 through 2027, in The Legal 500 United States for Healthcare: Health Insurers in 2023 and 2024, and in Washington, DC, Rising Stars for Health Care from 2022 through 2025. He developed URAC’s Mental Health Parity Accreditation Program and the industry’s first enterprise software solution for parity compliance.

• Professional Involvement

He serves as an accreditation reviewer for URAC’s Mental Health Parity Accreditation Program and teaches Managed Care Law and Policy as an adjunct professor at The George Washington University Law School. Earlier in his career he served as a Peace Corps volunteer in Zambia working in community agricultural development, coordinated a national domestic violence prevention program there, and conducted research on community health and social services programs in Washington, DC.

• Experience

He led the implementation of the 2013 Alternative Benefit Plan rollout at CMCS, the framework that added chronic substance use disorder to the medically frail categories and that CMS and the states used to operationalize the January 2014 Medicaid expansion. He spent six years in health care financing policy roles at the U.S. Department of Health and Human Services, led the federal implementation of the Mental Health Parity and Addiction Equity Act at the Substance Abuse and Mental Health Services Administration, and developed Medicare-Medicaid demonstration models for dual-eligible beneficiaries at the CMS Federal Coordinated Health Care Office. In private practice he represents Medicare Advantage organizations, Medicaid managed care plans, and Programs of All-Inclusive Care for the Elderly, and structures accountable care organizations under MSSP, ACO REACH, and the LEAD Model. He has served in embedded general counsel roles, including as seconded deputy general counsel for a regional health plan and acting general counsel for a national laboratory network, and advises on medical aid in dying law.

David Shillcutt, Member of the Firm | Epstein Becker & Green, P.C

David Shillcutt is a Member of the Firm at Epstein Becker & Green, P.C. in Washington, DC. He came to private practice from the Centers for Medicare & Medicaid Services, where he served as a Health Insurance Specialist in the Medicaid Division of Managed Care Plans, and his practice covers behavioral health, managed care, health policy and legislation, government and commercial coding, coverage, and payment, mental health parity, and privacy compliance strategies.

• Education & Credentials

He earned his J.D. from the University of Georgia School of Law in 2010 and his B.A., cum laude, from Harvard University in 2003. He is admitted to practice in the District of Columbia and Minnesota, and speaks French and Spanish.

• Recognition & Leadership

He serves as Vice Chair of the Behavioral Health Practice Group of the American Health Lawyers Association. He has been recognized in The Best Lawyers in America© “Ones to Watch” in Health Care Law from 2021 through 2023.

• Professional Involvement

He is a member of the American Health Lawyers Association’s Behavioral Health Task Force and of the District of Columbia Bar. Before entering law practice he taught at Lebanese International University in Lebanon, the American School in Sana’a in Yemen, Academia Holy Cross in Ecuador, and Central High School in Georgia.

• Experience

At the Centers for Medicare & Medicaid Services he served as a Health Insurance Specialist in the Medicaid Division of Managed Care Plans, working on the Medicaid managed care machinery through which states now administer and monitor coverage. At the Substance Abuse and Mental Health Services Administration he served as agency lead for regulatory affairs and led the drafting of mental health and substance use disorder parity regulations for Medicaid and CHIP — rulemaking directly adjacent to the substance use disorder and disabling mental disorder categories at issue in this program.

He entered federal service as a Presidential Management Fellow at the Center for Global Health at the Centers for Disease Control and Prevention. In private practice he advises academic medical centers, behavioral health providers, health plans, hospitals and health systems, life sciences companies, and post-acute and long-term care providers.

SESSION 1 – Documenting the Medical Frailty Exemption Before States Begin Enforcement | 1:00pm – 2:00pm

This session traces the medical frailty exemption from its statutory baseline in OBBBA (H.R. 1) § 71119, Pub. L. No. 119-21, and 42 U.S.C. § 1396a(xx)(9)(A)(ii)(V), through the 2013 Alternative Benefit Plan framework at 42 C.F.R. § 440.315(f), to the points at which CMS’s interim final rule departs from both. It covers the new “significantly impairs … community engagement” requirement at 42 C.F.R. § 435.554(c)(5)(i), the 12-month cap on the claims and encounter data states may rely on, and the narrowing of self-attestation beginning January 1, 2028. It then works category by category through what the record must show for each of the five statutory categories, including the five-year “stable recovery” carve-out for substance use disorder, and closes with a current read on Commonwealth of Massachusetts et al. v. Oz et al., No. 1:26-cv-12962 (D. Mass.), where the states’ motion for a preliminary injunction was denied without prejudice on July 29–30, 2026 and expedited summary judgment briefing is expected to resolve before enforcement begins January 1, 2027.

BREAK | 2:00pm – 2:10pm

SESSION 2 – Challenging Medicaid Terminations Through Fair Hearings and Federal Review | 2:10pm – 3:10pm

This session works through the community engagement requirement as it applies to clients with disabilities, beginning with the background sources of law — the statute and the interim final rule — and with the Medicaid categorical framework that determines when the work requirement does not apply at all. It separates the rule’s three operative terms, compliance, exception, and exclusion, and takes each in turn: the compliance standard and how it is assessed, the mandatory exceptions, the short-term optional exceptions, and the exclusions other than medical frailty, which Session 1 covers. It closes with verification of compliance, exclusion, and exception; notice and noncompliance procedures, including fair hearings, appeals, and “reasonably available documentation”; the use of managed care organizations and monitoring; and the litigation challenging the interim final rule.