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CMS Proposes Rule to Streamline Medicaid and CHIP Processes

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The Centers for Medicare & Medicaid Services (CMS) recently announced a proposed rule to streamline Medicaid and CHIP application, eligibility determination, enrollment, and renewal processes, as well as improve program integrity. Several of the changes would ease access to care and coverage for people who are dually enrolled in Medicare and Medicaid.

In a fact sheet accompanying the proposal, CMS explains that current policies can contribute to or fail to address enrollment and coverage barriers. As an example, the agency notes the Medicare Savings Program (MSP) enrollment process is overly complex, which likely contributes to widespread under-enrollment.

The MSPs are operated by state Medicaid agencies and can be a lifeline, helping people with limited income and savings afford their Medicare. MSP enrollees also automatically qualify for the federally run Part D Low Income Subsidy (LIS), or Extra Help, which pays certain prescription drug costs and is currently valued by the Social Security Administration as saving beneficiaries an average of $5,100 a year. Since these assistance programs free up limited enrollee dollars, they can also make other necessities, like food and housing, more affordable.

But MSP participation rates are troublingly low. An estimated 40% of those who are eligible—2.5 million people—are not enrolled. To help address this, the proposed rule includes several provisions to simplify MSP enrollment and renewal processes:

  • Better leveraging the LIS program to enroll in MSPs, including proposals to maximize the use of LIS “leads” data and define “family of the size involved” for MSP groups using the definition of “family size” in the LIS program.
  • Reducing the burden on applicants to produce certain types of documentation prior to enrollment.
  • Automatically enrolling certain Supplemental Security Income (SSI) recipients into the Qualified Medicare Beneficiary (QMB) group.
  • Facilitating enrollment in QMB by making the QMB effective date earlier in certain states. 
  • Improving retention in the MSPs by applying streamlined renewal processes for the Modified Adjusted Gross Income (MAGI) eligibility groups (such as people eligible for expansion Medicaid) to the non-MAGI groups, including the MSPs.  

We appreciate CMS’s efforts to improve MSP and LIS enrollment by reducing administrative burdens and programmatic inefficiencies. Increasing participation in these programs, which disproportionately serve beneficiaries in communities of color, is critical to improving health and economic security and advancing equity. We look forward to submitting comments. We will also continue to advocate for legislative changes that would further bolster MSP and LIS uptake, such as easing strict eligibility limits and expanding beneficiary outreach.

Read the proposed rule.

Read the CMS Fact Sheet, Streamlining Eligibility & Enrollment Notice of Proposed Rulemaking (NPRM).

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