The proposed rule would reduce red tape and simplify applications, verifications, and enrollment.

A new proposed rule would 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.

The Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS), announced in a notice of proposed rule making that it 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 health insurance. This proposed rule follows President Biden’s executive orders in April 2022 and January 2021 directing federal agencies to expand affordable, quality health coverage, including by strengthening Medicaid and the Affordable Care Act.

“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 in the announcement. “With these steps, we’re delivering on our promise to make high-quality health care more accessible and affordable for all Americans.”

CMS Administrator Chiquita Brooks-LaSure said the proposal would protect and strengthen health care coverage for more than 88 million people who are enrolled in Medicaid, CHIP, and the Basic Health Program. “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– 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,” Brooks-LaSure said.

If finalized, the rule would standardize 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 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 percent of the country’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.

The notice of proposed rulemaking aims to address these concerns and includes proposed options to provide easier access to and retention in health care coverage.

The proposal would:

  • End lifetime benefit limits in CHIP
  • Allow children to enroll in coverage right away by eliminating pre-enrollment waiting periods, consistent with nearly all other health coverage
  • 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
  • Simplifies processes to increase enrollment and retention for people who are 65 and older, as well as those who have blindness or a disability
  • Streamlines 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
  • Includes policies to improve access to programs that help make health coverage more affordable for older adults and individuals with disabilities
  • Simplifies enrollment for Medicare Savings Programs, which permit Medicaid to pay Medicare premiums or cost sharing for Medicare beneficiaries with lower incomes
  • Allows 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
  • 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
  • Update and standardize recordkeeping requirements for states, which would help to address deficiencies in outdated state recordkeeping systems and improve program integrity

The 301-page proposed rule is scheduled to be published in the Federal Register on Sept. 7. Once published, there will be a 60-day comment period. For more information, click here for the CMS fact sheet.