On August 31, 2022, CMS issued a proposed rule to reduce coverage gaps by streamlining the application, enrollment, and renewal process for coverage in Medicaid and the Children’s Health Insurance Program (CHIP) (the Proposed Rule). The Proposed Rule aims to make it easier for children, older adults, and individuals with lower incomes to enroll in and retain their coverage by easing the administrative burdens on the enrollees and establishing clear guidelines for the states.

Streamlining Application and Enrollment

CMS acknowledges in the Proposed Rule that the administrative burden of enrolling in Medicaid or CHIP prevents some eligible individuals from enrolling in coverage. The agency aims to make the application and enrollment process easier through changes such as:

• Modifying medically needy regulations to allow for the use of projected predictable medical expenses incurred by people living in the community—including home care and prescriptions—to be deducted from an applicant’s income to determine financial eligibility;
• Removing the requirements to apply for other benefits as a condition of Medicaid eligibility; and
• Ensuring automatic enrollment of Supplemental Security Income recipients into the Qualified Medicare Beneficiary group, with limited exceptions.

Additionally, the Proposed Rule includes changes specific to CHIP enrollment. The changes include:

• Allowing beneficiaries who fail to pay premiums to stay enrolled or re-enroll without a lock-out period;
• Eliminating the option to use a waiting period as a substitution of coverage prevention strategy; and
• Prohibiting annual and/or lifetime benefit limits.

Improving Retention Rates and Renewals

CMS says that it is also aiming to ensure continuous coverage and reduce the number of eligible individuals who lose coverage for a period of time. Some of the changes in the Proposed Rule include:

• Limiting renewals to once every 12 months, with limited exceptions;
• Providing a 90-day reconsideration period for individuals terminated for failure to return their renewal form but who subsequently return their form within the reconsideration period;
• Eliminating the in-person interview requirement;
• Establishing a clear process so that eligible beneficiaries can seamlessly transition between Medicaid and CHIP when their income changes; and
• Establishing clear processes and guidelines for states to properly evaluate eligible individuals before terminating them.

Enhancing Integrity of Medicaid and CHIP

The Proposed Rule also establishes standardized statewide renewal process and recordkeeping requirements through the following steps:

• Clearly defining information and documentation to be maintained by states with regards to eligibility determination;
• Removing references to outdated technology and requiring electronic storage of records;
• Requiring Medicaid and CHIP records to be retained for the time the case is active plus three years thereafter; and
• Providing specific timelines for states to complete Medicaid and CHIP renewals.

Comments on the Proposed Rule must be submitted to CMS by November 7, 2022.

The display copy of the Proposed Rule is available here, and it is expected to be published in the Federal Register on September 7, 2022. The CMS fact sheet on the Proposed Rule can be found here.