Policy & Regulation News

CMS Releases Medicaid CHIP Eligibility Enrollment Report

By Jacqueline DiChiara

- The Centers for Medicare and Medicaid Services (CMS) has released new information to assist states with Medicaid and the Children’s Health Insurance Program (CHIP) enrollment. CMS concurrently released the June 2015 monthly report on state Medicaid and CHIP eligibility and enrollment information.

Medicaid Children’s Health Insurance Program

According to Medicaid.gov, CMS is presenting states with the chance to utilize the Supplemental Nutrition Assistance Program (SNAP) gross income to back Medicaid eligibility for specific populations under the Medicaid state plan authority. As EHRIntelligence.com reported, health and human services agencies typically operate on a state or county level to provide essential services such as SNAP on limited budgets. 

“Based on discussions with states and stakeholders, [CMS] is offering optional strategies that can help make significant progress toward reducing the number of uninsured individuals and optional tools to help states manage the transition to their new eligibility and enrollment systems and coverage of new Medicaid enrollees,” confirms Cindy Mann, former Federal Director of Medicaid. “We intend to ensure a streamlined review and approval process for states interested in implementing these approaches.”

Enhanced federal matching funds, says Mann, are available to help pay for needed system revisions as long as systems meet applicable mandates – a 90 percent rate for development and a 75 percent rate for operations. Five enrollment strategies are outlined as followed for states considering adaptation:

  • Implementing the early adoption of Modified Adjusted Gross Income (MAGI)-based rules
  • Extending the Medicaid renewal period so that renewals that would otherwise occur during the first quarter of calendar year (CY) 2014 (January 1, 2014 – March 31, 2014) occur later
  • Enrolling individuals into Medicaid based on [SNAP] eligibility
  • Enrolling parents into Medicaid based on children’s income eligibility
  • Adopting 12-month continuous eligibility for parents and other adults.

“Under the Affordable Care Act, a new simplified system for enrolling eligible people into coverage will be in effect for Medicaid and [CHIP] in every state on January 1, 2014. In addition, in many states a new group of low-income adults will also become eligible for Medicaid coverage,” says Mann. “As states modernize their systems and extend Medicaid eligibility to the new adult group, they will be enrolling large numbers of people who become eligible all at once, either on January 1, 2014 or at a later date, as determined by the state.”

“Enrollment strategies that target individuals likely to be eligible for Medicaid, and for whom eligibility information is already in the state’s files, provide important advantages both for uninsured individuals and for states," confirms Mann. "Such ‘targeted enrollment strategies’ can efficiently identify and enroll eligible individuals and facilitate their renewal in Medicaid without requiring them to complete an entire new application. These strategies can also help alleviate the administrative demands on the new eligibility and enrollment system,” Mann maintains.

As RevCycleIntelligence.com reported, CMS issued a proposed care delivery rule last May to modernize CHIP and Medicaid Managed Care. The Medicare Access and CHIP Reauthorization Act (MACRA) of 2015 (H.R. 2) is alleged to increase combined federal spending for Medicare, Medicaid, and the health insurance marketplace by over $100 billion within the next decade.