New rule could remove barriers to program eligibility
Medicaid and the Children’s Health Insurance Program (CHIP) provide vital access to health and human services benefits for millions of people in the United States, including low-income individuals and families, pregnant women, aging adults and those with disabilities.
But when eligibility is lost, even for a brief time, the effects can be detrimental to those relying on these health services and supports to navigate daily life. Current cumbersome and confusing application and renewal processes contribute to “churn” – the term used to describe when program beneficiaries lose coverage and then re-enroll within a short period of time, resulting in lapses of healthcare coverage and sometimes changes in coverage.
The U.S. Centers for Medicare & Medicaid Services (CMS) identified several unnecessary administrative burdens and barriers to enrollment and retention following a series of executive orders from the Biden administration in January 2021 and April 2022. By September, a new proposed rule had been drafted to address some of the bigger challenges eligible beneficiaries and current program members face.
“Our goal is to ensure that eligible individuals can enroll and stay enrolled without unnecessary burden and that ineligible individuals are redirected to the appropriate coverage programs as quickly as possible,” according to the CMS.
The new rule standardizes eligibility and enrollment for Medicaid and CHIP programs and generally limits renewals to once per year with pre-populated renewal forms, to create more consistency and ease for program members across the nation.
Current renewal practices can be challenging to navigate, especially for those with functional limitations. The new rule would make Medicaid and CHIP enrollment and re-enrollment easier by:
- Eliminating requirements for in-person interviews
- Ensuring applicants have 30 days to respond to requests for information
- Pre-populating renewal forms
- Including a 90-day consideration period in cases where a beneficiary fails to meet a re-enrollment deadline
These and other components of the proposed rule will likely result in improvements of continuous coverage for Medicaid and CHIP members across the country.
Since its inception in 1965, there has been significant expansion in Medicaid eligibility, and as of June 2022, 82.3 million individuals were enrolled in Medicaid or CHIP programs nationwide. Much of the recent growth is due to the continuous enrollment requirement that went into effect during the COVID-19 pandemic public health emergency (PHE). As long as the PHE remains in effect, program enrollees cannot lose access to coverage.
CMS has made strides to improve enrollment and retention before. Today’s online application portals, for example, allow for faster eligibility determination and make it easier for state programs to renew member coverage at the appropriate times.
Medicaid and CHIP are federal programs administered by state agencies and lack continuity across state borders, creating just one of the many challenges for those eligible for benefits to not only obtain, but retain, coverage.
The proposed rule can be reviewed here and is open for public comment until November 7th.
FEI Systems has been a proud partner of CMS for more than 20 years. Our intimate knowledge of CMS programs helped us develop our comprehensive suite of information technology solutions targeted for state agencies administering Medicaid waiver programs for numerous targeted waiver populations. FEI’s Blue Compass suite of solutions creates stronger connections between communities, providers and department staff members across the continuum of care.
Blue Compass solutions assist in streamlining Medicaid enrollment by:
- Automating the entire enrollment and re-enrollment process for customer programs.
- Generating system-based alerts and notifications for key staff about needed contacts and documentation, including escalation if timelines are at risk.
- Capturing and supporting preferred communication methods to improve engagement with members.
- Providing process support with automatically generated forms, tasks, assignments and documentation requests from external sources.
- Reporting of all enrollment activities.
