CMS proposed rule would streamline Medicaid/CHIP enrollment and renewal course of


Medicaid, coverage,

The Biden-Harris Administration announced a new proposed rule Wednesday that would simplify the process for people to enroll and renew coverage in Medicaid, the Children’s Health Insurance Program (CHIP) and Basic Health Programs.

If finalized, the rule would limit renewals to once every 12 months, allow applicants 30 days to respond to information requests and require consistent renewal processes across states, the Centers for Medicare & Medicaid Services said in a news release.

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

The announcement comes as the end of the Covid-19 public health emergency nears, which is currently set for October but may be extended for another 90 days. When the emergency period ends, so does the continuous enrollment requirement, which so far has prohibited states from disenrolling Medicaid beneficiaries. In return, states receive a temporary increase in the federal Medicaid match rates. A recent HHS report projected that about 15 million people will lose coverage when the public health emergency ends.

Currently, the enrollment and renewal process is burdensome and deters many Americans from enrolling even when they’re eligible.

“We’re losing coverage because of a range of administrative processes,” said Daniel Tsai, deputy administrator and director of the Center for Medicaid and CHIP Services, on a call with reporters Wednesday.

One barrier Tsai mentioned is terminating an individual’s eligibility for coverage because they could not be reached by mail. The rule would create specific guidelines for states to check available data before taking away eligibility in this case.

“Many of the individuals we serve in Medicaid and CHIP move frequently and they lose coverage … not because they were ineligible, but because they did not receive a piece of paper in the mail and respond to that piece of paper,” he said.

Other proposed changes include, according to a fact sheet:

  • Removing the requirement to apply for other benefits as a condition of Medicaid eligibility.
  • Ensuring automatic enrollment of Supplemental Security Income recipients into the Qualified Medicare Beneficiary group, with limited exceptions.
  • Creating a clear process to prevent termination of eligible beneficiaries who need to be transitioned between Medicaid and CHIP when their income changes or when they’re eligible for the other program.
  • Allowing CHIP beneficiaries to stay enrolled or re-enroll without a lockout period for failing to pay premiums. 
  • Removing pre-enrollment waiting periods and prohibiting annual and/or lifetime limits on benefits in CHIP.
  • Cutting references to outdated technology and requiring records to be stored electronically.
  • Providing specific timelines for states to complete Medicaid and CHIP renewals.

There will be a 60-day comment period, after which the proposed rule will be reviewed by the U.S. Department of Health and Human Services.

Photo: designer491, Getty Images



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