Eligibility

On March 27, the Centers for Medicare & Medicaid Services (CMS) released the “Streamlining Medicaid, Children’s Health Insurance Program, and Basic Health Program Application, Eligibility Determination, Enrollment, and Renewal Processes” (CMS-2421-F2) final rule. The rule is designed to make it easier for millions of eligible people to enroll in and retain their Medicaid, Children’s Health Insurance Program (CHIP), and Basic Health Program (BHP) coverage.

On January 31, the U.S. Department of Health and Human Services’ (HHS) Office of the Assistant Secretary for Planning and Evaluation (ASPE) released a report titled “Medicare Enrollees and the Part D Drug Benefit: Improving Financial Protection through the Low-Income Subsidy.” The report highlights findings from an analysis of Medicare data from 2020, including that the Inflation Reduction Act’s (IRA) expanded financial assistance in Medicare’s Low-Income Subsidy (LIS) Program would have benefited nearly 461,000 Partial LIS enrollees had the provision been in effect in 2020. An additional 2.9 million Part D enrollees who were eligible but not enrolled in LIS would also have benefited from the program...

On January 11, Mathematica published a blog titled “A Quick Guide to Choosing Federal Medicaid Authorities to Address Health-Related Social Needs.” This blog explores the three most common federal Medicaid authorities that enable states to offer health-related social needs (HRSN) services to Medicaid-enrolled individuals: Section 1915 HCBS waivers, Managed Care In Lieu of Services (ILOS), and Section 1115 demonstrations. It also discusses key factors to contemplate as a state Medicaid official when choosing how to cover HRSN services, emphasizing considerations such as the intended population, types of services, and program features.

On Friday, November 11, 2022 HHS announced that it will again extend the COVID-19 Public Health Emergency (PHE). Based on commitments to provide at least 60 days’ notice prior to allowing the PHE to lapse, HHS had until Saturday, November 12, to provide states with notice that the PHE would either be extended or end in January. This means that unwinding protocol will not yet begin, and that the PHE policies such as Medicaid FMAP increases; continuous eligibility; and the 1135, Appendix K, and Emergency SPAs will remain in effect.

On Friday, October 28, 2022, CMS issued a final rule that simplifies Medicare enrollment and eligibility rules, extends coverage of immunosuppressive drugs for certain beneficiaries, and finalizes changes to improve state payment of Medicare premiums. Beginning January 1, 2023, individuals applying for Medicare premium Part A and Part B during the last three months of their Initial Enrollment Period or during the General Enrollment Period will have their coverage start the month after they enroll, reducing delays in coverage. The rule also allows certain Medicare special enrollment periods (SEPs) to permit Medicare Part B coverage without a late enrollment penalty.

This report highlights results from a 50-state GAO survey on what challenges states are experiencing related to federal Medicaid regulations. As part of the survey, GAO conducted interviews with state Medicaid officials to identify the areas of greatest concern. This report identifies four program areas that were rated as significant or moderate challenges to effective program administration. GAO also discusses potential federal actions to address these challenges

This recently released report examines the reforms, policy changes, and initiatives that occurred in FY 2018 and those adopted for implementation for FY 2019. The report focuses on changes in eligibility, managed care and delivery system reforms, long-term services and supports, provider payment rates and taxes, covered benefits, and pharmacy and opioid strategies.

The Centers for Medicare & Medicaid Services (CMS) released their monthly report for May 2016 on Medicaid and CHIP application, eligibility determination, and enrollment data. States provides data to CMS on factors related to key application, eligibility and enrollment processes using the Medicaid and CHIP Performance Indicator Project. The data is then used to inform CMS on the operations of the programs in each state and to share state performance data publicly.

The Centers for Medicare & Medicaid Services (CMS) released their monthly report for April 2016 on Medicaid and CHIP application, eligibility determination, and enrollment data. States provides data to CMS on factors related to key application, eligibility and enrollment processes using the Medicaid and CHIP Performance Indicator Project. The data is then used to inform CMS on the operations of the programs in each state and to share state performance data publicly.

The Employment Policy and Measurement Rehabilitation Research and Training Center, with funding from the National Institute on Disability and Rehabilitation Research, published a report on financing transition services. Multiple funding streams, or braiding of resources, are used to fund the services and supports available for transition-age youth seeking employment or higher education. This report examines who the payers of last resort are based on different regulatory and legal requirements.