January 22, 2018 On January 11, 2018, the Centers for Medicare and Medicaid Services (CMS) issued a State Medicaid Director Letter providing new guidance for Section 1115 waiver proposals that would impose work requirements (referred to as community engagement) in Medicaid as a condition of eligibility. With a proposal already approved for the Commonwealth of Kentucky and at least nine additional states poised to quickly follow suit, this hasty, ill-informed decision will create new barriers to health care for people with disabilities and further entrench workplace prejudices and stereotypes.