Updating the Eligibility and Enrollment Processes for Medicaid and the Children's Health Insurance Program (CHIP)

The Biden Administration recently proposed a new rule that would update the eligibility and enrollment processes for Medicaid and the Children’s Health Insurance Program (CHIP), making it much easier for people to enroll in and retain their Medicaid and CHIP coverage.

Here’s what you need to know: 

What is Medicaid & CHIP: Medicaid provides basic health care coverage to individuals and to those with Intellectual and Developmental Disabilities (IDD). It also provides coverage for community-based services, so that individuals can have help with daily tasks such as eating, hygiene, working, and more. CHIP is a program for children with IDD who are not eligible for Medicaid (due to a variety of reasons including those whose potential eligibility is based on being age 65 or older and/or having a disability). 

Who This Would Effect: Individuals with IDD and their families and individuals currently eligible for Medicaid.

How It Would Help: If the new rule is approved, it would make access to health and community-based services for independence (and overall well-being) much easier for individuals with IDD and their families to access. According to The Arc, the rule would improve both eligibility and enrollment policies. Renewals would be limited to once every 12 months and give applicants 30 days to respond to information, have prepopulated renewal forms, and have a consistent renewal process across states. 

Children in the CHIP program would also be able to remain enrolled/re-enroll without a lock-out period for failure to pay premiums, among other much-needed changes. 

According to the Centers for Medicare & Medicaid Services, additional benefits of the new rule would include (but are not limited to):

Eliminating the requirement to apply for other benefits as a condition of Medicaid eligibility to ensure eligible individuals, particularly those without an income test, are not facing unnecessary administrative hurdles. 

Ensuring automatic enrollment, with limited exceptions, of Supplemental Security Income (SSI) recipients into the Qualified Medicare Beneficiary (QMB) group.

You can learn more at the Centers for Medicare & Medicaid Services.