Administration overhauling Medicaid, CHIP enrollment
The rule would standardize certain eligibility and enrollment policies, such as limiting renewals to once every 12 months.
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In an effort to improve healthcare access, the Biden Administration has proposed a new rule that would overhaul the enrollment processes for Medicaid, the Children's Health Insurance Program (CHIP) and Basic Health Programs (BHPs), and eliminate what it considers arbitrary coverage caps for children in CHIP.
In a Notice of Proposed Rule Making, the Department of Health and Human Services, through the Centers for Medicare and Medicaid Services, is working to reduce red tape and simplify application and verification processes in a bid to make it easier for children, older adults and people with lower incomes with Medicaid and CHIP coverage to enroll in and retain insurance.
The rule follows President Biden's executive orders in April and in January 2021 directing federal agencies to take action to expand affordable, quality health coverage, including by strengthening Medicaid and the Affordable Care Act.
If finalized, the rule would standardize certain eligibility and enrollment policies, such as limiting renewals to once every 12 months, allowing applicants 30 days to respond to information requests, requiring pre-populated renewal forms, and establishing clear, consistent renewal processes across states.
WHAT'S THE IMPACT?
Medicaid and CHIP, said HHS, are critical sources of health insurance. Medicaid is the single largest health coverage program in the U.S., covering nearly one in four Americans and providing benefits with little to no out-of-pocket costs. Together, Medicaid and CHIP provide 51% of the nation's children and youth – more than 40 million children – access to healthcare.
But enrollment in these programs can be jeopardized because of cumbersome application or renewal processes and lack of uniformity in states across the country, the administration said. This NPRM takes aim at those concerns, and includes a suite of proposed options to provide easier access to and retention in healthcare coverage.
Among the proposals is to end lifetime benefit limits in CHIP and allow children to enroll in coverage right away by eliminating pre-enrollment waiting periods, consistent with nearly all other health coverage. The proposed rule would also permit states to transfer children's eligibility directly from Medicaid to CHIP when a family's income rises, preventing unnecessary redetermination processes from causing lapses in coverage.
The NPRM proposes simplifications geared to increase enrollment and retention for people aged 65 and older, as well as those who have blindness or a disability. The proposed rule, if finalized, would streamline the application process for these programs by removing administrative hurdles for people who do not have, but are eligible for, Medicaid, CHIP or BHP coverage. These people are often eligible for Medicaid, but are not yet enrolled or have trouble staying enrolled because of systemic barriers, said HHS, potentially missing lifesaving coverage and care because of burdensome processes.
The proposed rule also includes policies meant to improve access and affordability for older adults and people with disabilities. It offers ways to simplify enrollment for Medicare Savings Programs, which permit Medicaid to pay Medicare premiums or cost sharing for Medicare beneficiaries with lower incomes.
The proposed rule would also allow for automatic enrollment in Medicare Savings Programs for certain individuals receiving the Social Security Administration's Supplemental Security Income.
A recent study estimated that only about half of eligible low-income individuals enrolled in Medicare were also enrolled in Medicare Savings Programs. The proposed rule would automatically consider older adults for Medicare Savings Programs enrollment when they apply for low-income subsidies to help pay for Part D Medicare coverage, eliminating the need to complete multiple applications.
The rule would also update and standardize recordkeeping requirements for states, which HHS said would help to address deficiencies in outdated state recordkeeping systems and improve program integrity.
THE LARGER TREND
The Kaiser Family Foundation in May found that Medicaid enrollment has grown during the COVID-19 pandemic. Enrollment is expected to see a growth of about 25%, or 22.2 million enrollees, from 2019 through 2022, mainly due to the continuous enrollment requirement in place during the public health emergency.
KFF analysts project that, from fiscal year 2020 through fiscal year 2022, states will have collectively spent $47.2 billion to cover additional people enrolled in Medicaid because of the continuous enrollment requirement, and will have received $100.4 billion in new federal funds to cover those costs and provide general fiscal relief through enhanced Medicaid matching funds.
Based on the analysis, KFF estimates that enrollment will have risen to a projected 110.3 million by the end of 2022. That would be 22.2 million more people than were enrolled in 2019, before the pandemic.
Twitter: @JELagasse
Email the writer: jeff.lagasse@himssmedia.com
