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Final Rule Streamlines Medicaid, CHIP Enrollment

April 1, 2024
Julie Kozminski

A March 27 final rule from the Centers for Medicare & Medicaid Services (CMS) aims to facilitate enrollment and continuous coverage in Medicaid and the Children’s Health Insurance Program (CHIP) by removing administrative barriers, automating the renewal process, and updating outdated record-keeping regulations.

The final rule, Streamlining the Medicaid, Children’s Health Insurance Program, and Basic Health Program Application, Eligibility Determination, Enrollment, and Renewal Processes:

  • Prohibits states from conducting renewals more frequently than every 12 months and requiring in-person interviews for older adults and those with disabilities.
  • Requires states to provide all individuals with at least 15 days to provide additional information when applying for the first time and 30 days to return documentation when renewing coverage.
  • Establishes specific guidelines that, when a beneficiary cannot be reached, states must check available data before terminating eligibility.
  • Eliminates the requirement to apply for other benefits as a condition of Medicaid eligibility.
  • Establishes a process to prevent termination of eligible individuals transitioning between Medicaid and a separate CHIP program. CMS will require states to make determinations of and accept eligibility on behalf of the other program, as well as transfer the individual to the other program.

The rule also removes several barriers to CHIP enrollment by:

  • Removing lock-out periods when a family fails to pay a CHIP premium, allowing beneficiaries to reenroll immediately.
  • Removing the state option to require a waiting period before CHIP enrollment.
  • Prohibits annual and lifetime limits of CHIP benefits.

This rule will be effective 60 days after publication, although compliance dates vary by provision. Requirements related to improving transitions between Medicaid and CHIP will be effective upon publication, while states have 12 months after the effective date to comply with CHIP requirements.

The final rule is scheduled for publication in the Federal Register on April 2.

Contact Director of Policy Rob Nelb at rnelb@essentialhospitals.org or 202-585-0127 with questions.

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