Communications

(May 2, 2024) - On March 27, the Centers for Medicare & Medicaid Services  issued a final rule designed to streamline the eligibility and enrollment process for Medicaid and the Children’s Health Insurance Program. This proposed rule is the continuation of efforts by CMS to improve access and coverage for the Medicaid and CHIP populations by removing enrollment barriers and reducing coverage disruptions for eligible individuals as state Medicaid programs conduct eligibility redetermination following the conclusion of the COVID-19-related continuous coverage period.

 On March 27, the U.S. Department of Health and Human Services also concurrently released a new report highlighting  the continuous eligibility requirements Congress passed in December 2022, which took effect Jan. 1, could protect as many as 17 million children from coverage disruptions.

 Highlights of the proposed rule include:

•  Prohibiting annual and/or lifetime limits on CHIP benefits. Currently CHIP regulations do not prohibit such limits, and several states have implemented them on CHIP benefits. The proposed rule would prohibit such limits consistent with existing prohibitions in the Medicaid program. The final rule also removes the state option to require a waiting period prior to CHIP enrollment.
•  Allowing children covered by CHIP to remain enrolled or reenroll without a lockout period for failure to pay premiums. States currently have the regulatory option to impose a premium lockout period, which is a specified period a child or a pregnant individual must wait until being allowed to reenroll in the CHIP program after a certain period of non-payment of premiums. This policy change would align CHIP rules with those for the Medicaid program, which does not permit premium lockout periods.
• Establishing a clear process to prevent termination of eligible beneficiaries who should be transitioned between Medicaid and CHIP when their income changes or when the beneficiary appears to be eligible for the other program, even if the beneficiary fails to respond to a request for information.
• Clarifying states are permitted to establish an optional eligibility group for children with disabilities under age 21 whose eligibility is excepted from use of the Modified Adjusted Gross Income counting rules (e.g., for those living with a disability) or for other circumstances where such coverage is not already permitted in regulation.
• Requiring states to apply the same timeliness standard for renewal of enrollment as they do to initial applications. In addition, the rule would require states to allow sufficient time for beneficiaries to provide the documentation needed to retain enrollment (at least 15 days to return information related to an initial application and at least 30 days for information needed to retain enrollment). Finally, the rule provides states with options to use available information to update addresses when beneficiaries move within the state.
• Removing certain potential barriers to enrollment, such as requiring a person to apply for other benefits as a condition of Medicaid eligibility.
• Requiring states to conduct renewals no more than once every 12 months for those whose eligibility is based on being 65 or older, blind or disabled and prohibit requirements for in-person interviews for these populations. For these eligibility groups, states will also be required to use prepopulated renewal forms, provide a minimum 90-day reconsideration period after procedural termination, limit requests for information about a change in circumstances and accept renewals through multiple modalities.
• Includes a variety of program integrity provisions such as updating outdated recordkeeping regulations, removing regulatory references to outdated technology and establishing standards for retention of state records and case documentation.