New Final Rule Aims to Streamline Administrative Enrollment for Medicaid, CHIP, BHP

Its name might be a little unwieldy, but somewhat ironically, federal officials expect it’ll actually make managing enrollment in and engagement with certain federal health programs far more streamlined and simplified.

The Streamlining the Medicaid, Children’s Health Insurance Program (CHIP), and Basic Health Program (BHP) Application, Eligibility Determination, Enrollment, and Renewal Processes Final Rule was unveiled by the Centers for Medicare & Medicaid Services (CMS) this week, along with optimistic outlooks that its provisions will circumvent barriers to enrollment, update and build on the Patient Protection and Affordable Care Act’s (PPACA’s) coverage protections, and ensure that millions of Americans can get and keep their coverage.

“We know that removing red tape and administrative barriers helps people get and keep their health coverage – and gives security and peace of mind to American families. This rule extends insurance reforms included in the Affordable Care Act so that millions of children will not face barriers to enrollment or be at risk of losing the coverage they rely on to stay healthy,” U.S. Department of Health and Human Services Secretary Xavier Becerra said in a statement. “It removes outdated barriers to health insurance and helps fulfill the promise of the Affordable Care Act, especially for those in vulnerable and underserved communities. President Biden promised to expand access and lower costs – and this is another example of him delivering on that promise.”

“Our North Star is ensuring that everyone who is eligible for coverage can enroll and keep that coverage – so that they can get the healthcare they need. To that end, our work must start and end by breaking down barriers that prevent eligible people from connecting to coverage,” CMS Administrator Chiquita Brooks-LaSure added. “This historic rule will simplify the process for people who are eligible for our nation’s healthcare programs to maintain their connection to their healthcare providers. It means less time and money spent on unnecessary processes and more effort dedicated to protecting vital coverage for eligible people.”

Officials said the final rule, first proposed in September 2022, includes a series of provisions to simplify enrollment and renewal processes by standardizing them nationwide, bringing the consumer protections made possible by the PPACA to all enrollees in Medicaid and CHIP programs, and making it easier for eligible children and adults to stay covered. Specifically, the rule:

• Eliminates annual and lifetime limits on children’s coverage in CHIP;
• Ends the practice of locking children out of CHIP coverage if a family is unable to pay premiums;
• Eliminates waiting periods for CHIP coverage so children can access healthcare immediately;
• Improves the transfer of children seamlessly from Medicaid to CHIP when a family’s income rises;
• Requires states to provide all individuals with at least 15 days to provide any additional information when applying for the first time and 30 days to return documentation when renewing coverage; and
• Prohibits states from conducting renewals more frequently than every 12 months and requiring in-person interviews for older adults and those with disabilities.

Covering more than one in four Americans, Medicaid and CHIP provide comprehensive benefits with little to no out-of-pocket cost for tens of millions of Americans, including many from underserved and otherwise marginalized communities. Each state is responsible for operating its own program within federal requirements, meaning that the Medicaid and CHIP programs vary widely from state to state, meaning the new Final Rule will help close coverage gaps that exist regionally.

As of November 2023, federal figures showed that there were approximately 78.7 million Medicaid enrollees and 7.1 million CHIP enrollees nationwide. Paired with 65.7 million Medicare enrollees, that adds up to about 45 percent of the U.S. population being insured by one of the three federal health insurance programs, which account for about a quarter of the federal budget.

“Ensuring people can access the health coverage to which they are entitled is a foundational principle of health equity and a key priority for the Biden-Harris Administration,” CMS said in a press release. “Today’s rule fulfills President Biden’s January 2021 and April 2022 Executive Orders to strengthen Medicaid and access to affordable, quality coverage.”

Officials also noted that HHS released a new report this week showing that as many as 17 million children and youth will benefit from a provision Congress passed in December 2022 that ensures continuous eligibility and removes barriers to enrolling in and retaining such coverage.

“Additional anticipated updates to federal regulations by CMS later this year include improving managed care and strengthening access to the critical services Medicaid and CHIP offer,” the agency’s press release added. “These regulations can continue to pave the way for programs that are equitable, accessible, and person-centered.”

For more information on the Final Rule, visit the Federal Register at https://www.federalregister.gov/public-inspection/2024-06566/medicaid-program-streamlining-the-medicaid-childrens-health-insurance-program-and-basic-health.