Last week, the Biden-Harris administration (the Administration) announced a new rule simplifying the process for enrolling in Medicaid, the Children’s Health Insurance Program (CHIP), and the Basic Health Program (BHP). Additionally, to accommodate individuals who may soon lose Medicaid coverage due to the end of protections from the COVID-19 Public Health Emergency, HHS announced that it is extending the Special Enrollment Period for purchasing plans through the Affordable Care Act’s health insurance exchanges.

The Final Rule

On March 27, 2024, the Administration issued a final rule simplifying the enrollment requirements for the CHIP, Medicaid, and BHP programs. This rule will remove administrative barriers that could block eligible individuals from receiving CHIP, Medicaid, or BHP coverage. Some actions the rule takes include:

• Prohibiting states from requiring in-person interviews for individuals whose eligibility depends on age, blindness, or disability;
• Prohibiting states from requiring additional documentation to verify someone’s assets if that person provides information that is “reasonably compatible with information returned through an asset verification system;”
• Ending the requirement that individuals “apply for other benefits as a condition of Medicaid eligibility;” and
• Allowing states to determine an individual’s financial eligibility by deducting “projected predictable medical expenses” from their income.

In addition to easing enrollment requirements, the rule also imposes new restrictions on states before they can terminate a person’s coverage:

Requiring states to provide a “minimum 90-day reconsideration period” before terminating coverage due to a “failure to return information needed to redetermine eligibility” (for persons 65 and older, having blindness, or having a disability);

• Requiring states to provide members at least 30 days to return documentation requested for renewing coverage;
• Requiring states to provide prepopulated enrollment forms (for persons 65 and older, having blindness, or having a disability);
• “Eliminating annual and lifetime limits on children’s coverage in CHIP;” and
• “Ending the practice of locking children out of CHIP coverage” for families who cannot afford to pay premiums.

The final rule is scheduled to take effect June 1, 2024, sixty days after its anticipated April 2, 2024 publication date.

The Special Enrollment Period

On March 28, 2024, HHS announced that it is extending the end date for its temporary Special Enrollment Period from July 31, 2024 to November 30, 2024. During the COVID-19 Public Health Emergency, the federal government allowed states to receive a temporary 6.2 percentage point increase in their federal matching percentage in exchange for letting existing Medicaid enrollees keep their coverage during the emergency. This led to many people keeping their Medicaid coverage who may not have otherwise qualified. However, a “Medicaid unwinding” started on April 1, 2023, where states were once again allowed to terminate coverage for individuals who were no longer eligible, causing many to lose their coverage and creating a need to find alternatives.

Usually, people can only purchase plans through the Affordable Care Act’s health insurance exchanges during the Open Enrollment Period from November 1 through January 15. However, the federal government chose to extend the Special Enrollment Period to help prevent people from going uninsured due to the Medicaid unwinding. As the Medicaid unwinding continues and more patients leave Medicaid and enroll in exchange plans, providers can expect their patient mix to change accordingly.

The final rule can be found here, a fact sheet regarding the rule can be found here, and the Administration’s March 27, 2024 announcement can be found here. Additionally, HHS’s announcement regarding the Special Enrollment Period extension can be found here, and an explanation of the Medicaid unwinding process can be found here.