The final rule will make it easier for millions to sign up and keep their health coverage — including children, seniors and people with disabilities
The Biden-Harris administration today unveiled a final rule that will protect and improve the way millions of eligible people apply for, renew and maintain health coverage through Medicaid, the Children’s Health Insurance Program (CHIP) and the Basic Health Program (BHP) ). The Streamlining Medicaid, the Children’s Health Insurance Program, and the primary health care program application, eligibility determination, enrollment, and renewal processes The rule will eliminate red tape and barriers to enrollment, update and build on the Affordable Care Act’s (ACA) coverage protections, and ensure that millions of Americans can get and keep their coverage. With this rule, millions of Americans will benefit from a streamlined, less cumbersome enrollment process with reduced red tape, helping more people maintain coverage.
“We know that removing red tape and administrative barriers helps people get and keep their health coverage — and gives American families security and peace of mind.” This rule expands the insurance reforms included in the Affordable Care Act so that millions of children do not face barriers to enrollment or are at risk of losing the coverage they rely on to stay healthy,” said HHS Secretary Xavier Becerra. “It removes outdated barriers to health insurance and helps deliver on the promises of the Affordable Care Act, especially for those in vulnerable and underserved communities.” President Biden promised to expand access and reduce costs – and this is yet another example of him delivering on that promise.”
“Our North Star ensures that everyone who is eligible for coverage can enroll and keep that coverage — so they can get the health care they need. To that end, our work must begin and end with removing the barriers that prevent eligible people from connecting to coverage,” said CMS Administrator Chiquita Brooks-LaSure. “This historic rule will simplify the process for people who are eligible for our nation’s health care programs to maintain their relationship with health care providers. This means less time and money spent on unnecessary processes and more effort dedicated to protecting vital coverage for eligible people.”
The final rule, first proposed in September 2022, includes a series of provisions to simplify enrollment and renewal processes by standardizing them across the country, provide the consumer protections made possible by the ACA to all Medicaid and CHIP enrollees, and making it easier for eligible children and adults to stay covered, including:
- Eliminate annual and lifetime limits on CHIP coverage for children;
- Ending the practice of excluding children from CHIP coverage if the family is unable to pay premiums;
- Eliminate waiting periods for CHIP coverage so children have immediate access to health care;
- Improving children’s seamless transition from Medicaid to CHIP when family income increases;
- Requiring states to give all individuals at least 15 days to provide additional information when applying for the first time and 30 days to return documentation when renewing coverage; and
- Prohibiting states from doing renewals more often than every 12 months and requiring in-person interviews for seniors and people with disabilities.
Covering more than one in four Americans, Medicaid and CHIP provide solid benefits with little or no out-of-pocket costs to millions, including many in underserved communities. Each state is responsible for administering its own program within federal requirements. This resulted in a large amount of variation from state to state. As a result of this rule, federal Medicaid and CHIP enrollment rules have been strengthened across the country, ensuring that people are protected no matter where they live and helping people stay covered.
Ensuring that people have access to the health insurance they are entitled to is a foundational principle of health care equity and a key priority for the Biden-Harris administration. Today’s rule implements President Biden’s January 2021 and April 2022 executive orders to strengthen Medicaid and access to affordable, quality coverage.
Today’s rule also builds on CMS’s work during the Medicaid “roll-off,” which highlights how simplifying and streamlining renewals can dramatically help eligible people stay covered. For example, while families in some states have faced barriers to transferring a child’s coverage from Medicaid to CHIP during the waiver process, today’s rule will require all states to make that transition more seamless in the future.
HHS also released a new report today showing that about 17 million children and youth will benefit from a provision passed by Congress in December 2022 that ensures continued eligibility and removes barriers to enrolling and maintaining coverage.
Additional expected updates to federal regulations from CMS later this year include improving managed care and strengthening access to critical services offered by Medicaid and CHIP. These provisions can continue to pave the way for programs that are fair, accessible, and person-centered.
For more information about today’s rule, which supplements a rule published in September 2023 that finalizes changes for Medicaid and Medicare dual eligibles, visit the Federal Register at https://www.federalregister.gov/public- inspection/current.