Important Final Rule Streamlines Enrollment Into Medicaid

This week, the Centers for Medicare & Medicaid Services (CMS) finalized a rule to make enrolling and staying in Medicaid easier, especially for older adults and people with disabilities. This rule is a companion to one finalized last fall that streamlined enrollment into Medicare Savings Programs (MSPs).

Medicaid is a joint federal and state program with many different categories of coverage, each with its own eligibility rules and processes. These pathways include coverage for pregnant people, children, low-income adults between 19 and 64 who are not Medicare eligible (expansion Medicaid), and older adults and people with disabilities.

That last category, usually called “Aged, Blind, and Disabled” (ABD) Medicaid, has onerous enrollment and redetermination processes that can impede access to care. Administrative hurdles can include state requirements that applicants schedule in-person interviews or complete multiple rounds of redetermination paperwork within a 12-month period. Such barriers can make applying for or keeping benefits more difficult and often undermine health care goals and outcomes.

In the newly finalized rule, CMS aims to alleviate some of these challenges by clarifying federal minimum standards for ABD Medicaid application and redetermination processes. The rule bars in-person interviews for ABD Medicaid and requires states to provide a full year of eligibility before requiring redetermination paperwork. In addition, the rule simplifies other enrollment and verification processes, including requiring states to use prepopulated renewal forms and available data to make eligibility determinations, creating new timelines for applicants to submit needed documentation and for states to process applications, and establishing consumer protections around returned mail and address changes. The rule also clarifies existing policies to ensure state-to-state consistency and reduce non-compliance.

Medicare Rights supported these policies in our comments on the proposed rule, and we welcome this long-awaited finalization. These regulations, coupled with the MSP streamlining rule, eliminate some of the barriers that impede access to important financial assistance programs and will protect the health, economic stability, and well-being of older adults and people with disabilities.

Read more about the final rule.

Read more about the MSP final rule.

Read more about our work to improve MSP access in New York.

Read more about enrollment barriers and Medicaid churn.