Biden administration proposes rule to overhaul Medicaid, CHIP enrollment process

The Biden-Harris Administration proposed a new CMS rule Aug. 31 to overhaul the enrollment processes for Medicaid, the Children’s Health Insurance Program, and Basic Health Programs.

If finalized, the rule would streamline applications and standardize eligibility and enrollment policies nationwide.

Senior CMS officials told reporters the rule was developed with the ending of the federal public health emergency in mind. If the public health emergency ends Oct. 13, a redetermination process will begin a major disenrollment of Medicaid beneficiaries, potentially impacting up to 15 million people's coverage.

"The work we're doing on the ground right now with states is around immediate preparation of unwinding from the public health emergency," CMS officials said during the call. "We think many of the tactics we've been working on with states will actually line up quite well with the elements we've proposed in this rule for a later date, if we are able to finalize the rule in some way as proposed."

Five things to know:

  1. Lifetime benefit limits for CHIP coverage would end and children would no longer encounter pre-enrollment waiting periods.

  2. States would be allowed to transfer a child's eligibility from Medicaid to CHIP when their family's income increases, which would decrease the chances of a lapse in coverage during the redetermination process.

  3. There would be automatic enrollment in Medicare Savings Programs for certain individuals that receive Supplemental Security Income. Seniors that apply for subsidies to help pay for Part D coverage would automatically be considered for enrollment in Medicare Savings Programs.

  4. There would be standardization of state Medicaid and CHIP recordkeeping systems to prioritize electronic formats.

  5. There will be a 60-day comment period on the proposed rule, with comments submitted to the Federal Register no later than Nov. 7.

Read the full proposal here.

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