On Mar. 27, CMS fact sheet and final rule on streamlining enrollment.
CMS issued a final rule on Medicaid, children's health insurance program (CHIP), basic health program (BHP) application, eligibility decision, enrollment, and renewals.
Followed Sep. 2023 final rule to streamline Medicare enrollment; see #185489.
Also built on CMS’ work during Medicaid unwinding, which has highlighted how simplifying, streamlining renewals can dramatically help eligible people stay covered.
Extended date, flexibility to transition to Health Insurance Marketplace coverage.
Final regulation simplified process for eligible people to enroll in Medicaid coverage, keep their coverage, with goal of preventing eligible people from experiencing gaps.
In Medicaid due to burdensome administrative processes or unnecessary paperwork.
Included provisions intended to reduce number of eligible individuals who lose coverage and have to enroll again; specified additional requirements for individuals whose eligibility is based on being 65 or older, having blindness, or having a disability.
Removed barriers to CHIP enrollment that don’t apply to other affordability programs.
Updated recordkeeping requirements, improve integrity for state Medicaid, CHIP.
ACA Coverage Protections
Final rule included series of provisions to simplify enrollment and renewal processes by standardizing them nationwide, bringing consumer protections made possible by ACA.
To enrollees in Medicaid, CHIP programs; easier for children, adults to stay covered.
HHS also released report showing that as many as 17mn children, youth will benefit from provision Congress passed in Dec. 2022 that ensures continuous eligibility.
Key Provisions
Eliminated annual and lifetime limits on children’s coverage in CHIP.
Ended practice of locking children out of CHIP coverage if family cannot pay premiums.
Eliminate CHIP waiting periods so that children can access healthcare immediately.
Improve transfer seamlessly from Medicaid to CHIP when family's income rises.
Require States provide individuals at least 15 days to provide additional information when applying for first time, 30 days to return documents when renewing coverage.
Prohibit States from conducting renewals more frequently than every 12 months.
Also, required in-person interviews for older adults and those with disabilities.
Special Enrollment Period
Extended temporary special enrollment period (SEP) to help anyone no longer eligible for Medicaid/CHIP transition to Marketplace coverage in states using HealthCare.gov.
The end date of unwinding SEP will be extended from Jul. 31, 2024, to Nov. 30, 2024.
Effectiveness
Regulations effective 60 days after pending publication in the federal register.
Apr. 2024 CMS Fed Reg Final Rule
On Apr. 2, 2024, CMS published final rule in federal register, effective Jun. 3, 2024.
