CMS Releases Long-Awaited Proposed Rule to Ease Medicaid Enrollment Burdens

Before delving into CMS’ long-awaited proposed rule to ease Medicaid enrollment burdens, Medicaid and the Law would like to formally introduce its readers to Kian Azimpoor, a Law Clerk in the Washington, DC office who will serve as a regular contributor to the blog. Using his experiences from Capitol Hill and the MD Anderson Cancer Center, Kian looks forward to exploring the far-reaching impact of Medicaid and Medicare law.


On September 7, 2022, the Centers for Medicare and Medicaid Services (CMS) issued a proposed rule in the Federal Register to reduce red tape and make it easier for individuals to enroll and retain eligibility in Medicaid, the Children’s Health Insurance Program (CHIP), and the Basic Health Program.  CMS’ proposed rule was announced in response to President Biden’s January 2021 and April 2022 Executive Orders, which directed federal agencies to strengthen Medicaid access and expand affordable, quality health coverage.  Comments on the proposed rule are due November 7, 2022.

By way of background on the proposed rule, CMS cites to certain Medicaid and CHIP enrollment policies which can contribute to coverage disruptions and cause people to lose access to vital health services until they are re-enrolled.  Examples of barriers people may encounter under these programs include:

  • Children in some CHIP programs are subject to lockouts if their premiums are not paid.
  • Some CHIP programs institute annual or lifetime caps on benefits and required periods of uninsurance prior to enrollment.
  • A streamlined enrollment process does not exist for the Medicare Savings Programs, which are state Medicaid programs designed to help pay for Medicare premiums and cost sharing for low-income adults over the age of 65 or adults with disabilities.
  • Inconsistent state recordkeeping practices contribute to eligibility error rates. Notably, recordkeeping regulations were last updated over 30 years ago.

By simplifying applications, verifications, enrollment, and renewals, CMS seeks to retain coverage for eligible individuals and reduce barriers to enrollment.  Overall, the proposed rule intends to:

  • Standardize eligibility and enrollment policies, including providing applicants 30 days to respond to information requests;
  • Facilitate new enrollees, especially applicants who are eligible for both Medicare and Medicaid;
  • Align enrollment and renewal requirements for most Medicaid enrollees;
  • Ensure beneficiaries are protected in the event mail is returned;
  • Design timeliness requirements for applicants who are being reevaluated for Medicaid and CHIP eligibility;
  • Streamline easier transitions between Medicaid, CHIP, and the Basic Health Program;
  • Eliminate barriers to access for children enrolled in CHIP by forbidding premium lockout periods, waiting periods, and benefit limitations; and
  • Improve recordkeeping requirements to ensure proper documentation of eligibility and enrollment.

By streamlining Medicaid and CHIP eligibility and enrollment processes, CMS seeks to strengthen access to health coverage.  Below we have highlighted several of the more notable policies included in CMS’ proposed rule.

Removing Barriers to Enrollment and Streamlining Applications
If the proposed rule is finalized, the process of applying and enrolling in these programs will be streamlined.  For example, Supplemental Security Income recipients will be automatically enrolled in the Qualified Medicare Beneficiary (QMB) group.  The requirement that an individual must apply for other benefits as a condition of Medicaid eligibility will be eliminated to avoid unnecessary administrative burdens.  Additionally, the effective date of QMB coverage for an individual who enrolls in conditional Part A during the General Enrollment Period will be determined.  These proposals, amongst other requirements, will ease administrative burdens and streamline application, enrollment, and renewal processes in the Medicaid program.

Ensuring Equity and Access to Coverage
Eligible individuals for health coverage may experience financial hardship and, as a result, lose coverage.  To increase the number of eligible individuals who are covered, CMS’ proposed rule is designed to increase equity and improve program integrity.  Below are some of the proposed requirements:

  • Medicaid and CHIP renewals will not be conducted more than once every 12 months.
  • Prepopulated renewal forms will be used to ease renewals.
  • Required in-person interviews will be eliminated.
  • Systems will be improved to prevent the termination of eligible beneficiaries who transition from Medicaid and CHIP when their income changes.
  • Beneficiaries will be ensured sufficient time to provide documentation for retaining . Specifically, CMS proposes that states provide beneficiaries a minimum of 30 calendar days from the date a request for information is sent to ensure reasonable response time.
  • If a beneficiary cannot be reached due to returned mail, specific guidelines will be established so that states check for available data before terminating a beneficiary’s eligibility.
  • A minimum 90-day reconsideration period will be instituted after a beneficiary’s eligibility is terminated for failure to provide required documentation to re-determine eligibility.

Improving Access to CHIP Enrollment
Given how critical CHIP is to children as well as pregnant and postpartum individuals, CMS’ proposed rule eliminates lockout periods when CHIP beneficiaries fail to pay premiums.  Further, annual and lifetime caps on CHIP benefits will be prohibited.

Improving Access to Medicaid and CHIP
CMS notes that outdated recordkeeping regulations contribute to eligibility error rates and improper payments.  In response, the proposed rule seeks to update regulations and, thereby, enhance the integrity of Medicaid and CHIP.  In this effort, references to outdated technology will be removed and records will be stored in electronic format.  Further, Medicaid and CHIP records will be retained for three years after an applicant or enrollee’s case is evaluated or re-evaluated for Medicaid and CHIP eligibility.  Lastly, amongst other requirements, CMS will propose specific timelines for states to complete Medicaid and CHIP renewals.  Standardized timeframes will enable appropriate oversight of CMS programs.

Ultimately, CMS has proposed significant steps to make it easier for millions of Americans to enroll in and retain health insurance coverage.  Medicaid and CHIP serve more than 40 million children across the country, so these programs are critically important.  For applicable parties, comments on the notice of proposed rulemaking can be submitted to the Federal Register by November 7, 2022.

Leave a Reply

Your email address will not be published. Required fields are marked *