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  • Washington Highlights

    CMS Issues Final Rule Addressing Medicaid Eligibility and Enrollment

    Katherine Gaynor, Hospital Policy and Regulatory Analyst
    For Media Inquiries

    The Centers for Medicare & Medicaid (CMS) issued a March 27 final rule aimed at streamlining the process eligibility determinations, enrollment, and renewal processes for Medicaid, the Children’s Health Insurance Program (CHIP), and the Basic Health Program. The AAMC submitted comments on the proposed rule in 2022 [refer to Washington Highlights, Nov. 4, 2022].  

    The final rule seeks to reduce coverage disruptions, streamline eligibility and enrollment processes, reduce the administrative burden, and increase enrollment and retention of those who are eligible for these programs. Specifically, the rule will allow CHIP beneficiaries to reenroll without a lock-out period when a family fails to pay a CHIP premium, removes the state option to require a waiting period prior to CHIP enrollment, and will prohibit annual and lifetime limits on benefits in CHIP. Additionally, the proposed rule would more clearly define the types of eligibility determination information and documentation states are required to maintain. The final rule also includes provisions aimed at those who are 65 and older or have a disability by prohibiting in-person interview requirements, limiting renewals to no more than once every 12 months, utilizing prepopulated renewal forms, providing a 90-day recondensation period, limiting requests for information, and accepting renewals through multiple modalities for these beneficiaries.  

    Lastly, the rule includes policies to keep eligible individuals covered. These include requiring states to use certain types of available information to update addresses when individuals move within the state and establishes a minimum timeframe of at least 15 days for individuals to return information requested for an initial application and at least 30 days to provide documentation when needed to retain enrollment.