On April 2, the Centers for Medicare and Medicaid Services (CMS) published the most significant set of eligibility regulations since the initial rule implementing the Affordable Care Act (ACA). The new rule will help eligible individuals enroll in Medicaid and Children’s Health Insurance Program (CHIP) coverage and stay enrolled as long as they remain eligible. Many of the provisions address issues that contributed to coverage losses during the unwinding of the continuous enrollment provision that has resulted in at least 13.7 million people losing Medicaid coverage, mostly for procedural reasons.
The new rule is effective 60 days after publication, but because most of the new regulatory requirements will necessitate significant policy, operational, and system changes, CMS has set a three-year pathway for states to come into compliance. This approach attempts to balance the competing needs of making the streamlined processes available as soon as possible and responding to states’ capacity issues.