The Centers for Medicare & Medicaid Services finalized a rule Wednesday that would help beneficiaries enroll and remain enrolled in Medicaid coverage by easing eligibility requirements and reducing sign-up challenges.
Its goal is to prevent eligible Medicaid beneficiaries from experiencing coverage gaps by making enrollment a more straightforward and accessible process. To achieve this, the rule aims to reduce “burdensome administrative processes or unnecessary paperwork,” according to a statement by CMS.
When it was proposed in 2022, the rule drew praise from home care industry stakeholders for its potential to support the health and economic well-being of older adults.
“The systems and processes addressed in this rulemaking process are tremendously important,” LeadingAge said at the time in a comment on the proposed rule. “Timely and accurate redeterminations are essential, both for Medicaid beneficiaries and the providers that serve and support them.”
The finalized rule would first put an end to some inconvenient eligibility requirements for Medicaid beneficiaries. Most notably, it would remove the need for applicants to seek out other benefits before they can receive Medicaid coverage. Under the previous regulations, beneficiaries were required to take “all necessary steps to obtain other benefits to which they are entitled” before they could become eligible for Medicaid.
The new rule would also allow people to deduct projected, predictable medical expenses from their income when determining their financial eligibility for Medicaid-covered services. The switch allows home care patients to subtract monthly home care costs from overall income, which may help some beneficiaries receive additional coverage.
Finally, for those already enrolled in Medicaid, the final rule mandated that states must check all available beneficiary data before terminating a beneficiary’s coverage. It also established new determination processes for when a beneficiary cannot be reached or has changed address.
In recent months, many beneficiaries have had their enrollment procedurally terminated by a period of so-called “unwinding.” Oftentimes, states have failed to make reasonable efforts to reach enrollees before terminating their coverage, critics claim. Millions of beneficiaries, including thousands of home care patients, are expected to lose coverage by the time unwinding ends in July 2024.
CMS’ final rule responds to a pair of executive orders issued in 2021 and 2022 that aimed to simplify Medicaid access requirements. The pending measure is slated for publication on April 2.
