On June 12, 2023, the Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services, announced flexible policies that states can adopt to ensure a smooth transition to regular Medicaid operations.
In a corresponding letter to U.S. governors, HHS Secretary Xavier Becerra emphasized the importance of ensuring that individuals do not lose coverage due to administrative processes. The letter urged states to review their currently elected flexible strategies and to consider taking up existing and new policy offers to protect eligible individuals and families from procedural termination from Medicaid.
In addition to existing Strategies to Prevent Procedural Terminations, states also can adopt new strategies, including:
- Suspending the requirement to apply for other benefits under 42 CFR 435.608.
- Suspending the requirement to cooperate with the agency in establishing the identity of a child’s parents and in obtaining medical support.
- Permitting managed care plans to assist enrollees with completing and submitting Medicaid renewal forms.
- Renewing eligibility if able to do so based on available information and establishing a new eligibility period whenever contact is made with hard-to-reach populations.
- Delaying procedural terminations for beneficiaries for one month while the state conducts targeted renewal outreach.
- Designating the state agency as a qualified entity to determine presumptive eligibility (PE) on a modified adjusted gross income (MAGI) basis for individuals disenrolled from Medicaid or the Children’s Health Insurance Program (CHIP) for a procedural reason within a period elected by the state.
- Designating pharmacies, community-based organizations, and other providers as qualified entities to determine PE on a MAGI basis for individuals disenrolled from Medicaid or CHIP for a procedural reason within a period elected by the state.
- Reinstating eligibility effective on the individual’s prior termination date for individuals who were disenrolled based on a procedural reason and are subsequently redetermined eligible for Medicaid during a 90-day reconsideration period.
Contact Director of Policy Rob Nelb, MPH, at rnelb@essentialhospitals.org or 202.585.0127 with questions.
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