November in Review: CMS Issues Medicaid and CHIP Eligibility and Enrollment Guidance to States

Health Highlights

December 11, 2024

This overview is excerpted from Manatt on Health, Manatt’s subscription service that provides in-depth insights and analysis focused on the legal, policy and market developments. For more information on how to subscribe and to activate a complimentary one week trial to Manatt on Health, please reach out to Barret Jefferds.

Throughout the month of November, the Centers for Medicare & Medicaid Services (CMS) issued a series of sub-regulatory guidance and accompanying resources to support states’ compliance with federal Medicaid and Children’s Health Insurance Program (CHIP) application and renewal requirements. The suite of guidance lays out federal requirements and various state options, and offers illustrative scenarios in anticipation of state questions—particularly those related to verifying income and resource eligibility when using available data sources. The guidance and resources, described at a high-level below, can be found on CMS’s Unwinding and Returning to Regular Operations after COVID-19 webpage.

Future of Section 1902(e)(14) Waivers Guidance: On November 14, CMS released a Center for Medicaid and CHIP Services Informational Bulletin (CIB) and accompanying slide deck on how states can elect to extend permanently (beyond the previously established expiration date of June 30, 2025) many Section 1902(e)(14) waivers¹ that provide flexibility in how states conduct eligibility redeterminations for Medicaid and CHIP. In an effort to continue supporting state improvements to their eligibility and enrollment systems, CMS evaluated all Section 1902(e)(14) waivers to determine which could be implemented permanently through other federal authorities, given that Section 1902(e)(14) authority is time-limited. As a result, CMS has allowed states to continue permanently more than half of the unwinding-related Section 1902(e)(14) waivers. Notably, the flexibilities that had the biggest impact on increasing rates of ex parte renewals² and maintaining coverage for eligible individuals are now permanently available for states.
Evidence of Renewal Compliance Guidance: On November 15, CMS issued a supplemental document specifying the “evidence” that states must submit to CMS by December 31 as part of their post-unwinding compliance plans. The compliance guidance comes in follow-up to CMS’s September guidance on state compliance with federal renewal requirements, and CMS is requesting this evidence to verify state compliance with the federal standards, rather than relying solely on state assurances. CMS will evaluate state submissions and may request further supporting documentation on an as needed basis.
Financial Eligibility Verification Guidance: On November 20, CMS issued a CIB and an accompanying slide deck outlining state requirements and flexibilities for verifying financial eligibility. This guidance primarily focuses on verification requirements at application, though the November 26 guidance (see below) provides additional information on verification requirements during the ex parte renewal process.
Ex Parte Renewal Guidance: On November 26, CMS issued a CIB on the requirements for conducting eligibility renewals on an ex parte basis for Medicaid and CHIP enrollees (also see accompanying slide deck). This new guidance focuses on state implementation of federal ex parte renewal requirements and offers new state flexibility designed to increase ex parte renewal rates.

^[1]Section 1902(e)(14)(A) of the Social Security Act allows for waivers “as are necessary to ensure that states establish income and eligibility determination systems that protect beneficiaries.” During the unwinding period, these waivers were intended to help states increase ex parte renewal rates, support enrollees with updating their contact information and completing renewal forms, promote continuity of coverage and care, and facilitate the reinstatement of eligible individuals who were disenrolled for procedural reasons.

^[2] An ex parte renewal refers to an eligibility renewal of Medicaid and CHIP enrollees based on reliable information available to the state without contacting the enrollee. Also see the November 14 Assistant Secretary for Planning and Evaluation (ASPE) report, which evaluates Medicaid strategies to streamline ex parte renewals.

For more information on how to subscribe and to activate a complimentary one week trial to Manatt on Health, please reach out to Barret Jefferds.    