On January 11, 2018, the Centers for Medicare and Medicaid Services (CMS) distributed a State Medicaid Director letter outlining new guidelines for states about mandating work and other community engagement activities for adult Medicaid beneficiaries who are not aged, disabled, or pregnant. CMS defines community engagement broadly, as encompassing activities such as job search, education, skills training, caregiving, volunteer service, and treatment for substance use disorders; and suggests that such activities may be linked to better health outcomes.