NAMI Statement as Medicaid Community Engagement Requirements Take Effect

NAMI calls on policymakers to minimize coverage losses and protect access to mental health care

ARLINGTON, Va., Aug. 4, 2026 /PRNewswire/ -- The National Alliance on Mental Illness (NAMI) expressed strong concern and disappointment with the federal rule implementing new Medicaid community engagement requirements, or work requirements, which went into effect on July 31. Despite sustained advocacy from NAMI and the broader health care community over the last year, the new rule puts Medicaid coverage and access to lifesaving care at risk for millions of Americans nationwide.

"NAMI is deeply troubled that these new Medicaid community engagement requirements put Medicaid coverage and access to lifesaving mental health care at risk for people with mental illness," said Daniel H. Gillison Jr., CEO of NAMI. "Our work at NAMI is about people, and that's why we are worried. We are concerned that many eligible people will lose their Medicaid coverage, not because they no longer qualify, but because they are unable to navigate complex administrative requirements. We urge policymakers to do everything possible to minimize coverage losses and protect access to mental health care."

NAMI and more than 3,800 of its advocates submitted public comments urging the Administration to strengthen protections for people with mental illness. Health policy experts, providers, and patient advocacy organizations echoed those concerns, warning that the rule would have serious consequences for people with mental illness who are subject to the community engagement requirements.

NAMI's concerns are shared by the public: A recent NAMI-Ipsos poll found that most Americans oppose Medicaid coverage losses for people with mental illness under these requirements. A separate, voluntary survey of NAMI's membership also points to high levels of concern: People connected to the mental health community who opted to take the survey expressed overwhelming concern (97%) that people will lose their Medicaid coverage as a result of community engagement requirements.

The Medicaid community engagement requirements, which apply to certain populations covered by Medicaid expansion, were mandated in a law signed by President Trump in 2025. Although the law included protections for people with mental illness, the Administration's interpretation undermines those protections, requiring that individuals who meet the "medically frail" exclusion must also prove that their condition "significantly impairs" their ability to work. Because many mental health conditions can fluctuate in severity over time, a person may be able to work when their symptoms are well-managed and unable to work when those symptoms worsen. The Administration's interpretation of the "medically frail" exemption means they may be left without Medicaid coverage when their symptoms worsen and they need access to care the most.

NAMI has consistently voiced strong concerns about the rule's impact on people with mental illness and their families. NAMI National expressed its concerns during the public comment period, along with many NAMI State Organizations and Affiliates. NAMI also led a comment letter with the nation's leading mental health organizations and stood with leading patient advocacy groups to bring attention to the estimated coverage losses and consequences of this rule across entire communities.

NAMI advocates shared how community engagement requirements will impact people with mental illness. One NAMI advocate wrote:

"My symptoms are in constant flux, some months are better than others. I am on disability now, but the time it takes to be approved is long and this will affect those who are waiting to be designated as disabled. Many people who are waiting have symptoms that make it difficult. But to prove that their symptoms are preventing them from working, going to school, or volunteering, they could lose access to the care they need, when they need it most. This will affect long-term health and recovery of many individuals. Accessing the right care at the right time is an essential piece to recovery and the ability to improve to the point of no longer needing assistance."

NAMI will continue working with Congress, the Administration, Medicaid agencies, providers, and community partners to reduce harm by minimizing coverage losses among people impacted by these new requirements. NAMI will continue to help people with mental illness and their families navigate these upcoming changes.

The National Alliance on Mental Illness is the nation's largest grassroots mental health organization, dedicated to improving the lives of individuals and families affected by mental illness.

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SOURCE National Alliance on Mental Illness (NAMI)