CMS Final Rule: Streamlining Medicaid and CHIP Eligibility Determination, Enrollment, and Renewal Processes

The final rule from the Centers for Medicare & Medicaid Services (CMS) makes changes to simplify the eligibility and enrollment processes in Medicaid, the Children’s Health Insurance Program (CHIP), and the Basic Health Program. This rule aligns enrollment and renewal requirements for most individuals in Medicaid, creates timeliness requirements for redeterminations of eligibility, removes barriers to children enrolled in CHIP, and updates recordkeeping requirements.  These changes are intended to reduce coverage disruptions and increase retention of eligible individuals.  CMS also released new and updated resources to support the end of the Medicaid continuous enrollment, or ‘unwinding’, including guidance on unwinding processes and requirements for states; guidance to Medicaid managed care plans; and new resources for partners to help families navigate their state Medicaid fair-hearing process, such as if someone was determined no longer eligible for Medicaid.

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