The Biden-Harris Administration today unveiled a final rule that will protect and improve how millions of eligible people apply for, renew, and maintain health care coverage through Medicaid, the Children’s Health Insurance Program (CHIP), and the Basic Health Program (BHP). The Streamlining the Medicaid, Children’s Health Insurance Program, and Basic Health Program Application, Eligibility Determination, Enrollment, and Renewal Processes rule will remove red tape and barriers to enrollment, update and build on the Affordable Care Act’s (ACA’s) coverage protections and ensure that millions of Americans can get and keep their coverage. With this rule, millions of Americans will benefit from a modernized, less cumbersome enrollment process with reduced red tape, helping more people keep coverage.
“We know that removing red tape and administrative barriers helps people get and keep their health coverage—and gives security and peace of mind to American families. This rule extends insurance reforms included in the Affordable Care Act so that millions of children will not face barriers to enrollment or be 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 “It removes outdated barriers to health insurance and helps fulfill the promise of the Affordable Care Act, especially for those in vulnerable and underserved communities. President Biden promised to expand access and lower costs – and this is another example of him delivering on that promise.”
“Our North Star is ensuring that everyone who is eligible for coverage can enroll and keep that coverage – so that they can get the health care they need. To that end, our work must start and end by breaking down 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 connection to their health care providers. It 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 nationwide, bringing the consumer protections made possible by the ACA to all enrollees in Medicaid and CHIP programs, and making it easier for eligible children and adults to stay covered, including:
- 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.
Covering more than one in four Americans, Medicaid and CHIP provide robust benefits with little to no out-of-pocket cost for millions, including many from underserved communities. Each state is responsible for operating its own program within federal requirements. This has led to a large amount of variation from state to state. As a result of this rule, federal rules for Medicaid and CHIP enrollment are strengthened nationwide, ensuring people are protected regardless of where they live and helping people to stay covered.
Ensuring people can access the health coverage to which they are entitled is a foundational principle of health equity and a key priority for the Biden-Harris Administration. Today’s rule fulfills 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’ work during Medicaid “unwinding,” which has highlighted how simplifying and streamlining renewals can dramatically help eligible people stay covered. For example, while families in some states have faced barriers when transitioning a child’s coverage from Medicaid to CHIP during the unwinding process, today’s rule will require all states to make this transition more seamless in the future.
HHS also released a new report today showing that as many as 17 million children and youth will benefit from a provision Congress passed in December 2022 that ensures continuous eligibility and removes barriers to enrolling in and retaining coverage.
Additional anticipated updates to federal regulations by CMS later this year include improving managed care and strengthening access to the critical services Medicaid and CHIP offer. These regulations can continue to pave the way for programs that are equitable, accessible, and person-centered.
For more information on today’s rule, which complements a rule published in September 2023 that finalized changes for individuals dually eligible for Medicaid and Medicare, visit the Federal Register at https://www.federalregister.gov/public-inspection/2024-06566/medicaid-program-streamlining-the-medicaid-childrens-health-insurance-program-and-basic-health.
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