The Centers for Medicare and Medicaid Services (CMS) released a new rule in September that would simplify the steps of application and verification for those seeking coverage under Medicaid, the Children’s Health Insurance Program (CHIP), and the Basic Health Program. In this article, we examine the changes included in the new rule, their potential benefit to people with intellectual and developmental disabilities (I/DD) who want to pursue Medicaid enrollment, and how providers can submit public comments on the proposal.
Changes In The New Rule
The primary aim behind CMS’s new rule is to improve the enrollment process for all three programs, thereby increasing access to more people. Specifically, the new rule has been drafted with individuals with disabilities and people from underserved communities in mind. CMS hopes more people will become beneficiaries, rather than being denied coverage “because of systemic barriers,” and will be able to retain their coverage when it’s time to determine re-eligibility.
“This proposed rule will ensure that these individuals and families, often from underserved communities, can access the health care and coverage to which they are entitled.”
~ Chiquita Brooks-LaSure, CMS Administrator
Key changes include:
- Standardizing eligibility and enrollment to create consistency across all participating states. This would include limiting renewals to once per year, ensuring forms are pre-populated and that enrollees have 30 days to address any questions or requests associated with their application.
- Removing the requirement of an in-person interview for applicants.
- Requiring a 90-day reconsideration period when coverage has been terminated when an applicant fails to share requested information used to assess re-eligibility.
Potential Benefit To People With I/DD
Advocates are hopeful the proposed changes will help address concerns previously expressed to the Biden administration that individuals with I/DD are at greater risk of losing their coverage because it can be so difficult to navigate (and keep) their benefits.
“We frequently hear from people with disabilities and their families how incredibly overwhelming it is to get started, and once they have Medicaid or other federal health benefits, maintaining eligibility is a struggle due to red tape.”
~ Peter Berns, CEO of The Arc
Because those with I/DD often rely on Medicare for healthcare and home- and community-based services (HCBS), it is particularly important to ensure they are not faced with undue hardship or complication in accessing and maintaining services.
Public Comment Period
Public comment on the proposed rule is open through November 7, 2022 at 5:00pm EST. Comments can be submitted electronically, by regular mail, or by express/overnight mail.
Those commenting should refer to file code CMS-2421-P and allow adequate time if sending by regular mail to ensure comments are received by the deadline.
To read the full rule proposed by CMS, click here.