Proposed rule would reduce red tape and streamline administrative processes to help children, older adults, people with disabilities, and others from underserved communities connect to health care coverage through Medicaid and CHIP
Today, in a landmark effort to improve access to health care for millions of Americans, the Biden-Harris Administration proposed a new rule to overhaul the enrollment processes for Medicaid, the Children’s Health Insurance Program (CHIP), and Basic Health Programs (BHPs), and eliminate arbitrary coverage caps for children in CHIP. In a Notice of Proposed Rule Making (NPRM), the Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS), is working to reduce red tape and simplify application and verification processes to make it easier for children, older adults, and people with lower incomes with Medicaid and CHIP coverage to enroll in and retain vital health insurance. This proposed rule follows President Biden’s executive orders in April 2022 and January 2021 directing federal agencies to take action to expand affordable, quality health coverage, including by strengthening Medicaid and the Affordable Care Act.
Under the Biden-Harris Administration, thanks to the American Rescue Plan and other Administration efforts, more Americans than ever before have health insurance coverage. Today’s proposed rule will build on these efforts and support President Biden’s calls to strengthen Medicaid and access to affordable, high-quality health coverage.
“Medicaid and CHIP provide essential health care to millions of families across the country, and we are making it easier to enroll children and others in health insurance and to maintain coverage,” said HHS Secretary Xavier Becerra. “With these steps, we’re delivering on our promise to make high-quality health care more accessible and affordable for all Americans.”
“CMS is acting today to protect and strengthen health care coverage for the more than 88 million people enrolled in Medicaid, CHIP, and the Basic Health Program,” CMS Administrator Chiquita Brooks-LaSure said. “This proposed rule will ensure that these individuals and families, often from underserved communities, can access the health care and coverage to which they are entitled – a foundational principle of health equity. In addition, this proposed rule will help more people pay their Medicare premiums by making it easier for them to enroll in the Medicare Savings Programs.”
This rule, if finalized, would standardize commonsense eligibility and enrollment policies, such as limiting renewals to once every 12 months, allowing applicants 30 days to respond to information requests, requiring prepopulated renewal forms, and establishing clear, consistent renewal processes across states.
Medicaid and CHIP are critical sources of health care insurance for families across the country. Medicaid is the single largest health coverage program in the U.S., covering nearly one in four Americans and providing robust benefits with little to no out of pocket costs. Together, Medicaid and CHIP provide 51% of our nation’s children and youth – more than 40 million children – access to quality, affordable health care. However, enrollment in these programs can be jeopardized because of cumbersome application or renewal processes and lack of uniformity in states across the country. This NPRM takes aim at those concerns, and includes a suite of proposed options to provide easier access to and retention in health care coverage.
In a major transformation to the programs and a historic win for American families, the Biden-Harris Administration is proposing to end lifetime benefit limits in CHIP and allow children to enroll in coverage right away by eliminating pre-enrollment waiting periods, consistent with nearly all other health coverage. The proposed rule would also permit states to transfer children’s eligibility directly from Medicaid to CHIP when a family’s income rises, preventing unnecessary redetermination processes from causing lapses in coverage.
The NPRM proposes simplifications that would increase enrollment and retention for people age 65 and older, as well as those who have blindness or a disability. The proposed rule, if finalized, would streamline the application process for these programs by removing unnecessary administrative hurdles for people who do not have – but are eligible for – Medicaid, CHIP, or BHP coverage. These individuals are often eligible for Medicaid, but are not yet enrolled or have trouble staying enrolled because of systemic barriers, potentially missing life-saving coverage and care because of burdensome processes.
The proposed rule also includes policies that would improve access to programs that help make health coverage more affordable for older adults and individuals with disabilities. It offers ways to simplify enrollment for Medicare Savings Programs, which permit Medicaid to pay Medicare premiums or cost sharing for Medicare beneficiaries with lower incomes. The proposed rule would also allow for automatic enrollment in Medicare Savings Programs for certain individuals receiving the Social Security Administration’s Supplemental Security Income – a key goal for streamlining connections to care for those who need them most.
A recent study estimated that only about half of eligible low-income individuals enrolled in Medicare were also enrolled in Medicare Savings Programs. This proposed rule would automatically consider older adults for Medicare Savings Programs enrollment when they apply for low-income subsidies to help pay for Part D Medicare coverage, reducing the burdens of both time and expense by eliminating the need to complete multiple applications.
Lastly, proper documentation is critical to enabling appropriate oversight, identifying errors in state policies and operations, and reducing inconsistent and outdated practices across states, which contribute to improper payments. This proposed rule would update and standardize recordkeeping requirements for states, which would help to address deficiencies in outdated state recordkeeping systems and improve program integrity.
For more information on the NPRM, consult the fact sheet available at https://www.cms.gov/newsroom/fact-sheets/streamlining-eligibility-enrollment-notice-propose-rulemaking-nprm.
To review or comment on the NPRM during its 60-day public comment period, visit the Federal Register.