CMS Proposed Rule Would Streamline Enrollment for CHIP and Medicaid

Last Wednesday, the Centers for Medicare and Medicaid Services (CMS) issued a proposed rule that would streamline the application and renewal process for enrollees in Medicaid and the Children’s Health Insurance Program (CHIP).

The overhaul aims to “reduce red tape” and simplify the application and verification process for children, older Americans and low-income people. The rule comes as part of the Biden administration’s efforts to strengthen Medicaid and expand access to health coverage. From CMS Administrator Chiquita Brooks-LaSure:

CMS is acting today to protect and strengthen health care coverage for the more than 88 million people enrolled in Medicaid, CHOP and the Basic Health Program. 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.

States are currently prohibited from reviewing eligibility for current Medicaid and CHIP enrollees during the ongoing COVID-19 public health emergency. Once that expires, 15 million people are expected to lose coverage, but the U.S. Department of Health and Human Services projects that 6.8 million who are still eligible will lose coverage due to administrative roadblocks. Modern Healthcare reports that the rule aims to limit these coverage departures by limiting the eligibility renewals to no more than once per year, eliminating mandatory in-person interviews and limiting questions about changes in beneficiary circumstance.

Furthermore, the rule would require states to check available data before terminating benefits when enrollees cannot be reached, and to create a process for transitioning people from CHIP to Medicaid. CMS also proposes throwing out a rule that certain people must apply for other benefit programs prior to seeking Medicaid.

Healthcare Dive notes that the rule will also initiate applications for the Medicare Savings Program (MSP), and will allow people who use low-income subsidies to qualify for MSP coverage “to the maximum extent possible.”