CMS Issues Additional Guidance for Medicaid, CHIP Renewals

The Centers for Medicare and Medicaid Services (CMS) on March 15 released an informational bulletin and slide deck on permissible practices for Medicaid and Children’s Health Insurance Program (CHIP) renewals during and after the unwinding period. States that do not comply with renewal requirements must change their practices as soon as possible and can receive technical assistance from CMS.

The guidance discusses Medicaid and CHIP renewal requirements:

1. States cannot terminate Medicaid or CHIP coverage for an individual who has returned their renewal form or documentation requested by the state within the eligibility period, even if processing the renewal form or documentation will need to occur after the eligibility period has ended.
2. States cannot terminate Medicaid coverage without first determining eligibility for all other eligibility groups.
3. States cannot require a new application from individuals who are eligible on the basis of modified adjusted gross income (MAGI) and who respond to a renewal request within 90 days after a procedural termination.
4. States cannot exclude an individual from ex parte renewal because wage data show that a household earner is working for a different employer than what is reflected in the case record if their income remains below the applicable standard.
5. States cannot exclude individuals for an ex parte renewal in Medicaid solely because the state has aligned renewal dates with deadlines for the Supplemental Nutrition Assistance Program or other human services benefit programs.
6. States cannot transition an individual to the marketplace or to another Medicaid eligibility category with lesser benefits or increased premiums or cost sharing based on ex parte review without first sending a renewal form and request for information.
7. States cannot terminate coverage or take other adverse action before providing advance notice, including an explanation of fair hearing rights.
8. States cannot conduct ex parte renewals at the household level. States must complete a redetermination of eligibility based on available information for each individual in the household.
9. States must provide at least 30 days for the response to a renewal form for individuals whose eligibility is based on MAGI.
10. States cannot send renewal forms, adverse action notices, and other notices only in English, without providing language services, to households that have requested information in other languages, or fail to ensure effective communication with individuals with disabilities.

CMS strongly encourages all states to review their renewal processes, including standard operating procedures, renewal forms, and notices, and to test the renewal logic in eligibility systems.

Contact Director of Policy Rob Nelb, MPH, at rnelb@essentialhospitals.org or 202.585.0127 with questions.