CMS Announces New Proposed Rule to Streamline Medicaid and CHIP Eligibility and Enrollment

The Centers for Medicare and Medicaid Services (CMS) announced a forthcoming proposed rule entitled Streamlining the Medicaid, Children’s Health Insurance Program, and Basic Health Program Application, Eligibility Determination, Enrollment, and Renewal Processes. The goal of the rule is to make it easier for millions of eligible individuals to enroll in and retain their Medicaid coverage. The rule would simplify applications, verifications, enrollment, and renewals for health care coverage through Medicaid and the Children’s Health Insurance Program (CHIP). The official release of the rule of scheduled for September 7, 2022, and there will be a 60-day comment period.

The proposed rule would make several critical changes to streamline application and eligibility. One such change would be to modify the “medically needy” regulations to allow for the use of projected predictable medical expenses incurred by people living in the community—including home care and prescription drugs—for purposes of deducting these expenses from the applicant’s income to determine financial eligibility. The proposed rule would also provide additional flexibilities for beneficiaries such as prohibiting requirements of in-person interviews and providing sufficient time and process for beneficiaries to provide documentation and update contact information.

For more information, CMS issued a press release and created a fact sheet.