“As you point out in your letter, some beneficiaries who are eligible for Medicaid on a basis other than disability have an illness or disability (as defined by other federal statutes) that may interfere with their ability to meet work and community engagement requirements as well as make the completion of paperwork or reporting in a timely manner difficult. States must comply with federal civil rights laws, ensure that beneficiaries with disabilities are not denied Medicaid for inability to meet these requirements and have mechanisms in place to ensure that reasonable modifications are provided to people who need them. States should include, in their proposal to CMS, information regarding for plans for compliance with these requirements. The reasonable modifications requirement must include exemptions from participation where a beneficiary is unable to participate for disability-related reasons, modification in the number of hours of participation required where a beneficiary is unable to participate for the required number of hours, and provision of support services necessary to participate, where participation is possible with supports.”
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