When the COVID-19 Public Health Emergency (PHE) ended in April 2023, the Families First Coronavirus Response Act’s Medicaid continuous enrollment condition also came to an end. The condition had allowed states to claim a temporary monetary incentive for not disenrolling persons enrolled in Medicaid during the PHE, among other conditions. When this monetary incentive disappeared, many states moved quickly to disenroll recipients from the Medicaid program. In response to this trend, the Centers for Medicare & Medicaid Services (CMS) published an interim final rule (Rule) on Dec. 6, implementing reporting requirements and enforcement authorities created by the Consolidated Appropriations Act of 2023.
The Rule seeks to limit the extent to which states are removing Medicaid recipients from the program by instituting punishments for states that kick recipients out of the program for procedural reasons as opposed to eligibility considerations. For example, some states had been using procedural or administrative issues, such as the failure to renew within the required timeline or not updating contact information, as justification for disenrollment. Any noncompliance or failure to reinstate eligibility for affected individuals could subject the state to enforcement authorities, including requiring states to submit and participate in a corrective action plan, suspending disenrollments from Medicaid for procedural reasons, imposing fees on the state via civil money penalties, and applying a reduction to the State’s Federal Medical Assistance Percentage.
In order to promote transparency and hold states accountable for adhering to redetermination requirements, the Rule also requires that states submit to CMS a report on the activities of the State relating to eligibility redeterminations conducted between April 1, and June 30, 2024. The reports require several specific data elements, such as the number of eligibility renewals initiated or the number of individuals determined eligible for a qualified health plan, and CMS intends to make such reports public. Failure to follow reporting requirements could similarly result in enforcement actions taken against the State by CMS, including the application of a reduction to the state specific FMAP.
The regulations became effective on December 6, with public comments due by February 2, 2024.
