Medicaid, CHIP enrollment to streamline under HHS proposed rule

The US Department of Health and Human Services aims to make enrollment in government health care programs easier for low-income children, people with disabilities, and seniors by cutting red tape., according to a proposal announced on Wednesday.

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

Children covered by CHIP would no longer face waiting periods before enrollment or lifetime benefit limits under the proposed rule. Automatic inclusion of health savings programs, as proposed, would make them easier to access for low-income seniors and some people with disabilities. And renewals under healthcare programs would be limited to once every 12 months.

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

The proposed rule follows the passage of the Cut Inflation Act – praised for its investment in health care but criticized as a scaled-down version of the multi-trillion-dollar package that President Joe Biden had hoped to enact. year — and on the precipice of ending the COVID-19 public health emergency, which could lead to a massive loss of Medicaid coverage.

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

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How children are affected by the proposal

To meet a Social Security law requirement that states must include in their plans a description of how they ensure that CHIP coverage will not replace group health plan coverage, 36 states initially instituted uninsured waiting periods.

Now, only 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 But the policy is outdated, said Joan Alker, the center’s executive director, and even a few months without insurance can have dangerous ramifications for families.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 face high medical bills, high gas costs — even a fall on the playground can lead to a broken arm, and a trip to the emergency room can send a family bankrupt,” Alker said. at USA TODAY.

The new rule would also allow states to transfer children’s eligibility directly from Medicaid to CHIP when a family’s income increases, reducing the likelihood of coverage interruptions while eligibility is re-determined.

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

The proposed rule Streamline the application and registration processes for people aged 65 and over and people with blindness or other disabilities.

It would automate consideration for seniors when applying for low-income subsidies to help pay for Medicare Part D coverage, and it would automate some enrollments for people receiving Supplemental Security Income in savings programs. Medicare, which help people eligible for Medicare pay for some of the cost of coverage.

“When we talk about people eligible for Medicare savings programs, we’re talking about some of the weakest and most vulnerable seniors,” said Allison Orris, senior fellow at the Center on Budget and Policy Priorities.

Bethany Lilly, senior director of public policy for Arc USA, 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. help overcome the paperwork barriers often associated with government health care programs.

“Even with the help of family and the help of health care providers, sometimes it’s not enough to just go through that paperwork because it’s so complicated,” Lilly said. “These kinds of changes for people with disabilities are really important because they reduce the burden not only for people with disabilities, but also for their family members on people trying to help them get those services.”

The official end of the pandemic complicates coverage

With the passage of the Inflation Reduction Act, the additional grants included in the 2021 COVID-19 relief package for people who purchase their own insurance have been extended to 2025.

However, millions of Americans — between 5 million and 14 million, according to an estimate by the Kaiser Family Foundation — could lose Medicaid as states begin to cut coverage when the Biden administration declares the public health emergency COVID- 19 is over. The most recent renewal of the state of health emergency, carried out in July, is due to expire in mid-October.

“It’s a very scary thing,” Alker said. “I know the administration is worried about it. We are worried about this. A lot of people are worried about this, and it’s going to take a huge effort to avoid a massive loss of coverage.

The 12-month continuity rule could potentially help Americans stay 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 officially end, but we know that COVID-19 is always going to be with us, maybe endemic, not epidemic, which means it’s still going to affect a lot kids like the flu still does,” Brito said. “Therefore, it is really important that children are vaccinated against COVID-19, influenza and other vaccine-preventable diseases in a timely manner… This rule will help in that regard.”

However, the proposed rule is unlikely to come 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 being finalized. An administration official said the agency hopes to release the finalized rule next year.

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