CMS final rule aims to simplify Medicaid, CHIP enrollment, coverage

A new CMS final rule, the “Streamlining the Medicaid, Children’s Health Insurance Program, and Basic Health Program Application, Eligibility Determination, Enrollment, and Renewal Processes” rule, aims to modernize and optimize the Medicaid enrollment process, according to a press release from CMS.

The rule was proposed in September 2022 in response to Executive Orders from President Joe Biden. It also addresses the Medicaid unwinding that has resulted in 18 million Medicaid disenrollments at the time of this publication.

“This historic rule will simplify the process for people who are eligible for our nation’s health care programs to maintain their connection to their health care providers. It means less time and money spent on unnecessary processes and more effort dedicated to protecting vital coverage for eligible people,” CMS Administrator Chiquita Brooks-LaSure emphasized.

Medicaid renewal and enrollment processes will be affected by the new rule. States cannot initiate renewals more than once a year and they must wait 30 days to receive renewal documentation. Seniors and those with disabilities will no longer be required to attend in-person interviews. New enrollees will have 15 days to submit additional information.

The rule addresses specific Children’s Health Insurance Program (CHIP) policies that may result in delayed care. For example, to streamline enrollment in CHIP, the rule strikes down the annual and lifetime limits on CHIP coverage. It also eradicates CHIP coverage waiting periods.

The Biden Administration’s rule seeks to crack down on coverage disruptions. The new rule eliminates a practice that allows children to be “locked out” of CHIP coverage for 90 days if the family cannot cover the CHIP premium. Additionally, when families’ incomes improve, the rule aims to improve the transition out of Medicaid coverage and into CHIP.

CMS sought to improve the integrity of Medicaid and CHIP. For example, the rule offered clearer definitions around certain documentation that states must manage. Medicaid and CHIP programs must maintain case documents while the case is active and three years after the case turns inactive. The rule also stripped away outdated technology references.

“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,” Department of Health and Human Services (HHS) Secretary Xavier Becerra explained in the press release.

“It removes outdated barriers to health insurance and helps fulfill the promise of the Affordable Care Act, especially for those in vulnerable and underserved communities.”