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Department of Health and Human Services

Exclusive: Biden administration moves to streamline Medicaid, CHIP enrollment

The proposed rule, provided first to USA TODAY, takes steps to reduce the paperwork burden often associated with health care.

Ella Lee
USA TODAY

The U.S. Department of Health and Human Services aims to make enrolling in government health care programs easier for low-income kids, disabled people and older adults by cutting red tape, according to a proposal announced Wednesday.

The proposed rule, provided first to USA TODAY, takes steps to reduce the paperwork burden often associated with health care by streamlining applications and standardizing policies and requirements across states for Medicaid, Basic Health Programs and the Children's Health Insurance Program, or CHIP.

Children covered by CHIP would no longer face pre-enrollment waiting periods or lifetime benefit limits under the proposed rule. Automatic consideration for Medicare Savings Programs, as proposed, would make accessing them more simple for low-income seniors and some people with disabilities. And renewals under the health care programs would be limited to once every 12 months. 

If implemented as proposed, 2.81 million more people are projected to enroll in Medicaid over the next five years, thanks to easier enrollment processes, according to HHS.

The proposed rule comes on the heels of the Inflation Reduction Act's passage – lauded for its investment in health care but criticized as a scaled-back version of the multitrillion dollar package President Joe Biden hoped to pass last year – and on the precipice of the end to the COVID-19 public health emergency, which could cause massive Medicaid coverage loss.

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“Medicaid and CHIP provide essential health care to millions of families across the country, and we are making it easier to enroll children and others in health insurance and to maintain coverage,” HHS Secretary Xavier Becerra said in a statement. “With these steps, we’re delivering on our promise to make high-quality health care more accessible and affordable for all Americans.”

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How kids are affected by the proposal

To answer a requirement in the Social Security Act that says states must include in their plans a description of how they ensure CHIP coverage won't substitute for coverage under group health plans, 36 states originally instituted uninsured waiting periods.

Now, just 12 states have waiting periods, which range from one month to 90 days, according to Georgetown University's Center for Children and Families. But the policy is outdated, said Joan Alker, the center's executive director, and even a few months without insurance can have dangerous ramifications for families.

"Families are facing high medical bills, high gas costs — even one fall on the playground can result in a broken arm, and one trip to the ER can send a family into bankruptcy," Alker told USA TODAY. 

The new rule would also allow states to transfer children's eligibility directly from Medicaid to CHIP when a family's income rises, decreasing the likeliness of lapses in coverage while eligibility is redetermined. 

How older adults and people with disabilities are affected by the proposal

The proposed rule would streamline application and enrollment processes for people aged 65 and older and people who have blindness or another disability.

It would automate consideration for older adults when they apply for low-income subsidies to help pay for Part D Medicare coverage, and it would automate some enrollments for individuals receiving Supplemental Security Income into Medicare Savings Programs, which help people eligible for Medicare pay for some of the costs of coverage.

"When we talk about people who are eligible for the Medicare Savings Programs, these are some of the lowest income, most vulnerable seniors," said Allison Orris, a senior fellow at the Center on Budget and Policy Priorities.

Bethany Lilly, senior director of public policy for The Arc of the United States, which advocates for people with intellectual and developmental disabilities, described the proposed rule as a "game changer" for people with disabilities who may need help overcoming the paperwork hurdles often associated with government health care programs.

"Even with help from family and help from health care providers, it sometimes isn't enough to get through this paperwork because it is so complicated," Lilly said. "These kinds of changes for people with disabilities are really important because it reduces the burden not only on people with disabilities, but also on their family members on the people who are trying to help them get these services."

Pandemic's formal end complicates coverage

With the passage of the Inflation Reduction Act, extra subsidies included in the 2021 COVID-19 relief package for people who purchase their own insurance were extended through 2025.

However, millions of Americans – between 5 million and 14 million, according to a Kaiser Family Foundation estimate – could lose Medicaid as states start to unwind coverage when the Biden administration declares the COVID-19 public health emergency to be over. The most recent renewal of the public health emergency, made in July, is scheduled to expire in mid-October.

“It’s a very scary thing,” Alker said. “I know the administration is worried about that. We're worried about that. Lots of people are worried about that, and there's going to have to be a huge effort to avoid a mass coverage loss.”

The 12-month continuity rule could eventually help Americans remain protected against COVID-19 by ensuring they have access to vaccines, said Dr. Arturo Brito, CEO of the Children's Health Fund.

"The COVID-19 public health emergency may come to an official end, but we know that COVID-19 is still going to be with us, perhaps in an endemic fashion, not an epidemic fashion, meaning it is still going to impact children much like the flu still does," Brito said. "Therefore, it's really important that children receive timely vaccination for COVID-19, for influenza, and for other vaccine preventable diseases...This rule will help in that way."

However, it's unlikely the proposed rule would go into effect before the unwinding process begins, Orris said.

What happens next?

After a 60-day public comment period, the proposed rule will be reviewed by HHS before it is finalized. An administration official said the agency hopes to publish the finalized rule next year.  

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