The proposed rule would reduce bureaucracy and simplify administrative processes to help children, the elderly, people with disabilities and others from disadvantaged communities connect to health coverage through Medicaid and CHIP
Today, in a pivotal effort to improve access to health care for millions of Americans, the Biden-Harris administration proposed a new rule to review enrollment processes for Medicaid, Children’s Health Insurance Program (CHIP) and Basic Health. Programs (BHPs) and eliminate arbitrary coverage limits for CHIP children. In a proposed regulation notice (NPRM), the Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS), is working to reduce bureaucracy and simplify the application and verification processes for make it easier for children, seniors, and low-income people with Medicaid and CHIP coverage to sign up for and maintain vital health insurance. This proposed rule follows President Biden’s executive orders in April 2022 and January 2021 that ordered 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 have health insurance coverage. The proposed rule today 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 for children and others to enroll in health insurance and maintain coverage,” said HHS Secretary Xavier Becerra. “With these steps, we deliver on our promise to make high-quality healthcare more accessible and affordable for all Americans.”
“CMS is taking action today to protect and strengthen health coverage for the more than 88 million people enrolled in Medicaid, CHIP and the Primary Health Program,” said CMS administrator Chiquita Brooks-LaSure. “This proposed rule will ensure that these individuals and families, often from disadvantaged communities, can access the health care and coverage they are entitled to, a fundamental principle of health equity. In addition, this proposed rule will help more people pay their Medicare premiums by making it easier to enroll in Medicare savings programs. ”
This rule, if finalized, would standardize common sense eligibility and enrollment policies, such as limiting renewals to once every 12 months, giving applicants 30 days to respond to inquiries, requesting pre-filled renewal forms, and establishing renewal processes clear and consistent across states.
Medicaid and CHIP are key sources of health insurance for families across the country. Medicaid is the largest health coverage program in the United States, covering nearly one in four Americans and providing solid benefits with little or no out-of-pocket costs. Together, Medicaid and CHIP provide 51 percent of our nation’s children and youth – more than 40 million children – access to affordable, quality healthcare. However, enrollment in these programs can be compromised due to cumbersome application or renewal procedures and lack of uniformity in states across the country. This NPRM targets these concerns and includes a suite of proposed options to provide easier access and maintenance of health coverage.
In a major program transformation and a historic victory for American families, the Biden-Harris administration proposes to end the lifetime benefit limits in CHIP and allow children to sign up for coverage immediately by eliminating pre-waiting periods. enrollment, consistent with almost all other health coverage. The proposed rule would also allow states to transfer children’s eligibility directly from Medicaid to CHIP as a family’s income rises, preventing unnecessary redetermination processes from causing coverage drops.
The NPRM proposes simplifications that would increase enrollment and retention for people aged 65 and over, as well as for those who are blind or disabled. The proposed rule, if finalized, would simplify the application process for these programs by removing unnecessary administrative barriers for people who do not have, but are eligible, Medicaid, CHIP or BHP coverage. These people are often eligible for Medicaid, but are not yet enrolled or have difficulty staying enlisted due to systemic barriers, coverage and potentially missing life-saving care due to onerous processes.
The proposed rule also includes policies that would improve access to programs that help make health coverage more accessible for older people and people with disabilities. It offers ways to simplify enrollment in Medicare savings programs, which allow Medicaid to pay Medicare premiums or cost-sharing for lower-income Medicare beneficiaries. The proposed rule would also allow automatic enrollment in Medicare savings programs for some people earning the Social Security Administration’s supplemental security income, a key goal to streamline connections to care for those who need it most.
A recent study estimated that only about half of eligible low-income people enrolled in Medicare were also enrolled in Medicare savings programs. This proposed rule would automatically consider seniors to enroll in Medicare savings programs when they apply for low-income benefits to help pay for Medicare Part D coverage, reducing the time and expense burden by eliminating the need to complete multiple applications.
Finally, proper documentation is critical to enable adequate oversight, identify errors in state policies and operations, and reduce inconsistent and outdated practices between states, which contribute to improper payments. This proposed rule would update and standardize record keeping requirements for states, which would help fill gaps in outdated state record keeping systems and improve program integrity.
For more information on NPRM, see 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 Registry.