Biden Administration Makes Enrolling in Medicaid and CHIP Easier for Millions

Millions of Americans will find it easier to enroll in and keep Medicaid, Children’s Health Insurance Program (CHIP), and Basic Health Program (BHP) coverage under a new rule finalized by the Centers for Medicare & Medicaid Services (CMS). The Streamlining Medicaid, Children’s Health Insurance Program, and Basic Health Program Application, Eligibility Determination, Enrollment, and Renewal Processes Final Rule aims to reduce red tape and administrative burdens, promoting greater access to healthcare for underserved populations.

The new rule builds upon President Biden’s Executive Orders to strengthen Medicaid and CHIP access. It specifically targets reducing unnecessary administrative burdens and paperwork that can lead to coverage gaps or loss of coverage for eligible individuals.

Key Changes for Easier Enrollment and Retention

  • Reduced in-person requirements: States can no longer require in-person interviews for individuals applying for Medicaid based on age (65 or older), blindness, or disability.
  • Simplified information sharing: The rule emphasizes using electronic data verification systems to streamline the income and asset verification process.
  • Elimination of unnecessary hurdles: Applying for other benefits will no longer be a mandatory step for Medicaid eligibility.
  • Streamlined eligibility determination: States can now consider projected medical expenses when determining financial eligibility.
  • Extended renewal periods: Renewals for eligible individuals will be conducted no more than once every 12 months, with a minimum 90-day reconsideration period in case of missed information.
  • Multiple renewal options: Renewals can now be submitted online, by phone, mail, or in-person.
  • Clearer transition process: A smoother transition process is established for individuals who may become eligible for either Medicaid or CHIP based on income changes.
  • Improved address tracking: States are required to utilize available data sources to update beneficiary addresses when they move within the state.
  • More time for submitting information: Individuals will have a minimum of 15 days to respond to initial application requests and 30 days to provide documentation when needed for renewal.

Focus on Children’s Health Coverage

This final rule also includes specific measures to remove barriers to CHIP enrollment for children:

  • Elimination of lock-out periods: CHIP beneficiaries can now re-enroll without penalty if their families previously failed to pay premiums.
  • Removal of waiting periods: States can no longer impose waiting periods before CHIP enrollment.
  • Prohibition on coverage limits: Annual and lifetime limits on CHIP benefits are no longer allowed.

Enhancing Program Integrity

The rule also includes updates to record-keeping requirements for state Medicaid and CHIP agencies. These updates aim to improve program oversight and reduce improper payments. Key changes include:

  • Clearer documentation standards: The rule defines the types of information and documentation required for eligibility determination.
  • Standardized record retention: Records must be retained for at least three years.
  • Electronic record storage: Outdated storage methods are phased out, requiring electronic record-keeping.
  • Improved access to records: States must make records available within 30 days upon request.
  • Timely eligibility determinations: States are required to establish minimum timeframes for determining eligibility at renewal and following changes in circumstances.

This new final rule is expected to significantly reduce administrative burdens for both individuals seeking coverage and state agencies administering Medicaid, CHIP, and BHP programs. By simplifying the enrollment and renewal processes, millions of eligible Americans will have easier access to affordable health insurance.

Sources

  1. healthcaretoday.news/its-public-benefits-week-in-the-federal-register/
  2. www.hhs.gov/about/news/2024/03/27/biden-harris-administration-builds-success-affordable-care-act-streamlining-enrollment-medicaid-chip-coverage

 


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