CMS: Final Rule Medicaid and CHIP Eligibility

From Family Voices

The Centers for Medicare & Medicaid Services (CMS) has issued a FINAL RULE aimed at simplifying the Medicaid, Children's Health Insurance Program (CHIP), and Basic Health Program (BHP) application and renewal processes. Published on March 27, 2024, this rule marks a significant effort to enhance enrollment efficiency and ensure eligible individuals enroll in and maintain access to vital health care coverage.

The finalized rule seeks to streamline eligibility and enrollment processes across Medicaid, CHIP, and BHP. Here are some important aspects of the rule:

• Eliminating annual and lifetime limits on children’s coverage in CHIP;
• Ending the practice of locking children out of CHIP coverage if a family is unable to pay premiums;
• Eliminating waiting periods for CHIP coverage so children can access health care immediately;
• Improving the transfer of children seamlessly from Medicaid to CHIP when a family’s income rises;
• Requiring 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
• Prohibiting states from conducting renewals more frequently than every 12 months and requiring in-person interviews for older adults and those with disabilities.

The final rule goes into effect 60 days following publication in the Federal Register, approximately June 3, 2024.