CMS final rules standardizes Medicaid enrollment and renewal 

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The Centers for Medicare and Medicaid Services has released a final rule to standardize the Medicaid enrollment and renewal process nationwide.

Currently, each state is responsible for operating its own Medicaid program within federal requirements. This has led to a large amount of variation from state to state.

This became an issue after states began the Medicaid redetermination process on April 1, 2023, ahead of the public health emergency ending on May 11 last year. In August 2023, CMS issued a call to action to states about a potential state systems issue related to automatic renewals that was causing individuals to be inappropriately disenrolled from Medicaid, even when the state had information indicating the person remained eligible.

The unwinding caused millions to lose coverage. Ten months after states began the redetermination process, an estimated 16 million beneficiaries lost Medicaid coverage, according to a KFF analysis.

WHY THIS MATTERS

The rule helps ensure that Medicaid and CHIP enrollees, especially children, retain their coverage, CMS said. It  improves how millions of eligible people apply for, renew and maintain healthcare coverage through Medicaid, the Children's Health Insurance Program (CHIP) and the Basic Health Program (BHP).

The rule, called "Streamlining the Medicaid, Children's Health Insurance Program, and Basic Health Program Application, Eligibility Determination, Enrollment and Renewal Processes," was first proposed in August 2022. It includes a series of provisions to simplify enrollment and renewal processes by standardizing them nationwide, bringing the consumer protections made possible by the Affordable Care Act to all enrollees in Medicaid and CHIP programs, and making it easier for eligible children and adults to stay covered, including:

• Eliminating annual and lifetime limits on children's coverage in CHIP.
• Ending the practice of locking children out of CHIP coverage if a family is unable to pay premiums.
• Eliminating waiting periods for CHIP coverage so children can access health care immediately.
• Improving the transfer of children seamlessly from Medicaid to CHIP when a family's income rises.
• Requiring states to provide all individuals with at least 15 days to provide any additional information when applying for the first time and 30 days to return documentation when renewing coverage.
• Prohibiting states from conducting renewals more frequently than every 12 months and requiring in-person interviews for older adults and those with disabilities.

THE LARGER TREND

Medicaid and CHIP covers more than one in four Americans, with little to no out-of-pocket costs.

The rule fulfills President Biden's January 2021 and April 2022 Executive Orders to strengthen Medicaid and access to affordable, quality coverage.

HHS also released a new report showing that as many as 17 million children and youth will benefit from a provision Congress passed in December 2022 that ensures continuous eligibility and removes barriers to enrolling in and retaining coverage.

CMS is expected to release additional updates to federal regulations later this year to improve managed care and strengthen access to the critical services Medicaid and CHIP offer.

ON THE RECORD

"We know that removing red tape and administrative barriers helps people get and keep their health coverage – and gives security and peace of mind to American families," said HHS Secretary Xavier Becerra. "This rule extends insurance reforms included in the Affordable Care Act so that millions of children will not face barriers to enrollment or be at risk of losing the coverage they rely on to stay healthy."

Email the writer: SMorse@himss.org