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Medicaid, CHIP Enrollment Process Streamlined in CMS Proposed Rule

Analysis  |  By Jay Asser  
   September 02, 2022

The federal agency is striving to make it easier for eligible people to enroll in and continue their Medicaid coverage.

The Biden administration has proposed a new rule to overhaul the application and renewal process for Medicaid and other government programs like the Children's Health Insurance Program (CHIP), CMS announced.

By simplifying enrollment and verification processes, CMS is aiming to make it easier for children, older adults, and people with lower income to both attain and retain Medicaid and CHIP coverage.

With the COVID-19 public health emergency slated to end on October 13, the proposed rule comes at a time when states are beginning to notify Medicaid beneficiaries about potentially losing coverage.

The proposal includes standardizing eligibility and enrolment policies like limiting renewals to once every 12 months to allow applicants 30 days to respond to information requests.

It would also end lifetime benefit limits in CHIP, allowing children to enroll in coverage immediately by doing away with pre-enrollment waiting periods. Children's eligibility would transfer directly from Medicaid to CHIP when a family's income rises, preventing an unnecessary redetermination process.

For adults aged 65 and older, as well as those with a disability, the proposed rule would remove unnecessary administrative hurdles for individuals who are eligible for the government programs.

"This proposed rule will ensure that these individuals and families, often from underserved communities, can access the health care and coverage to which they are entitled – a foundational principle of health equity," CMS administrator Chiquita Brooks-LaSure said in a statement.

Other changes in the proposal include:

  • Establish 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 when the beneficiary fails to respond to a request for information.
  • Ensure automatic enrollment, with limited exceptions, of Supplemental Security Income recipients into the Qualified Medicare Beneficiary group.
  • Eliminate the requirement to apply for other benefits as a condition of Medicaid eligibility to ensure eligible individuals to reduce unnecessary administrative hurdles.
  • Propose specific timelines for states to complete Medicaid and CHIP renewals, including guidelines to ensure beneficiaries who return information late are properly evaluated for other eligibility groups prior to being terminated.

Jay Asser is the contributing editor for strategy at HealthLeaders. 

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