Setting the Record Straight on the Medicaid Eligibility and Enrollment Rules

The Biden-Harris Administration finalized two important rules to make it easier for eligible people — primarily children, seniors, and people with disabilities — to access and retain Medicaid. Unfortunately, some Republicans — looking for Medicaid cuts in budget legislation to offset the cost of extending tax cuts for the wealthy — are advocating to reverse these rules and reinstate barriers that make it harder for eligible people to access Medicaid coverage. Repealing the rules would save costs mainly because fewer eligible people would enroll. Put another way, the cost savings would come at the expense of low-income people’s access to health care.

Let’s be clear: The main effect of the updated Medicaid rules is to increase enrollment of already eligible people; the rules do not expand Medicaid eligibility.

The data-driven rules address key administrative barriers in the Medicaid enrollment and renewal processes so that eligible people aren’t deterred from enrolling because of bureaucratic red tape or because they aren’t able to navigate the complex Medicaid application and renewal processes.

The rules make technical changes to reduce burden so eligible people can enroll and stay enrolled; to leverage accurate, automated data sources; and to increase program efficiency:

• The first rule, Medicare Savings Program Eligibility Determination and Enrollment, finalized September 21, 2023, simplifies and streamlines the process for low-income seniors and people with disabilities who receive Medicare to access Medicare Savings Programs (MSPs). MSPs are part of state Medicaid programs and pay for Medicare premiums and often cost-sharing charges, lowering costs for enrollees. Many of the provisions make it easier for low-income people who have applied to the Social Security Administration for help paying for prescription drugs to enroll in MSPs.

• The second rule, Streamlining the Medicaid, Children’s Health Insurance Program, and Basic Health Program Application, Eligibility Determination, Enrollment, and Renewal Processes, finalized April 2, 2024, simplifies the eligibility and enrollment process for Medicaid, the Children’s Health Insurance Program (CHIP), and the Basic Health Program (BHP), reducing administrative barriers for individuals applying for and renewing their health coverage.

  Changes include prohibiting states from requiring in-person interviews of seniors and people with disabilities; requiring states to use updated address information from reliable sources and to reach out to enrollees when mail is returned as undeliverable; updating recordkeeping rules to reduce error rates; and eliminating access barriers for children in CHIP by prohibiting premium lock-out periods (a period of ineligibility due to non-payment of premiums), annual or lifetime benefit limitations, and waiting periods (a forced period of uninsurance after loss of other coverage before being able to enroll in CHIP.)

Changes under the rules, like requiring seniors and people with disabilities to complete complicated renewal processes every 12 months (instead of every six months), keep eligible people from churning off the program and reduce their interactions with unclear forms, complex verification requirements, and overwhelmed caseworkers and call centers because of inadequate staffing at state agencies. Enrollees are still required to report changes during their eligibility period, and the state agency must still act on changes it becomes aware of.

These Medicaid eligibility and enrollment rules take important steps to reduce administrative red tape for eligible families and improve government efficiency. Congress should leave them in place, not roll them back.