CMS Requires States to Pause Disenrollments and Reinstate Coverage for Impacted Individuals
The U.S. Department of Health and Human Services (HHS) announced that it has helped half a million children and families regain their Medicaid and Children’s Health Insurance (CHIP) coverage. On August 30, the Centers for Medicare & Medicaid Services (CMS) issued a call to action to states about a potential state systems issue where systems were inappropriately disenrolling children and other enrollees, even when the state had information indicating the person remained eligible. Thanks to CMS’ swift action, nearly 500,000 children and other individuals who were improperly disenrolled from Medicaid or CHIP will regain their coverage, and many more are expected to be protected from improper disenrollments going forward.
CMS sent a letter on August 30 to all states, the District of Columbia, Puerto Rico, and the U.S. Virgin Islands requiring them to determine and report whether they have a systems issue that inappropriately disenrolls children and families, even when the state had information indicating that they remained eligible for Medicaid and CHIP coverage. Today’s summary indicates that to-date 30 states report having this systems issue. As a result, to avoid CMS taking further action, all 30 states were required to pause procedural disenrollments for impacted people unless they could ensure all eligible people are not improperly disenrolled due to this issue.
“Thanks to swift action by HHS, nearly half a million individuals, including children, will have their coverage reinstated, and many more will be protected going forward. HHS is committed to making sure people have access to affordable, quality health insurance – whether that’s through Medicare, Medicaid, the Marketplace, or their employer,” said HHS Secretary Xavier Becerra. “We will continue to work with states for as long as needed to help prevent anyone eligible for Medicaid or CHIP coverage from being disenrolled.”
“Medicaid and CHIP are essential for millions of people and families across the country,” said CMS Administrator Chiquita Brooks-LaSure. “Addressing this issue with auto-renewals is a critical step to help eligible people keep their Medicaid and CHIP coverage during the renewals process, especially children. CMS will keep doing everything in our power to help people have the health coverage they need and deserve.”
CMS’ letter on August 30 alerted states to a potential eligibility systems issue related to automatic renewals for Medicaid and CHIP coverage. Auto-renewals (also known as “ex parte” renewals) are one of the strongest tools that states have to keep eligible people enrolled in Medicaid or CHIP coverage during the renewals process. Federal rules require states to use information already available to them through existing reliable data sources (e.g., state wage data) to determine whether people are still eligible for Medicaid or CHIP. Auto-renewals make it easier for people to renew their Medicaid and CHIP coverage, helping to make sure eligible individuals are not disenrolled due to red tape. CMS continues to provide technical assistance to states as they address these system issues.
Throughout the renewals process, CMS has offered states many strategies to assist them in making it easier for people to renew their coverage. Nearly all states have adopted at least some of these strategies, and CMS continues to urge states to adopt these strategies. Additionally, to help make transitions from Medicaid to other health coverage options more accessible in every state, CMS has launched national marketing campaigns and made available Special Enrollment Periods through HealthCare.gov, State-based Marketplaces, and Medicare. CMS’ top priority remains making sure everyone has access to affordable, quality health coverage.
For a preliminary overview of state assessments regarding compliance with Medicaid and CHIP automatic renewal requirements at the individual level (as of September 21, 2023), visit: https://www.medicaid.gov/resources-for-states/downloads/state-asesment-compliance-auto-ren-req.pdf.