The Seattle Indian Health Board (SIHB) strongly objects to the Centers for Medicare and Medicaid Services’ (CMS) recent actions and statements regarding the imposition of work requirements and other restrictive conditions on Medicaid eligibility for American Indians and Alaska Natives (AI/AN). CMS’s position that tribes are not eligible for exemptions to these Medicaid work requirements runs contrary to long-settled issues of Constitutional law and Congressional intent. In order to carry out the federal government’s Trust Responsibility to AI/AN, CMS is obligated to exempt AI/AN people from these community engagement requirements.