CMS Finalizes Medicaid Rule to Streamline Enrollment Into Medicare Savings Programs

Kinda Serafi, Manatt Health

Introduction

On September 18, 2023, the Centers for Medicare & Medicaid Services (CMS) released a final rule, “Streamlining Medicaid; Medicare Savings Program Eligibility Determination and Enrollment.” The final rule largely maintains, with some modest changes, the Medicare Savings Program (MSP) provisions in the proposed rule that was released on August 31, 2022. The remaining provisions of the August 2022 proposed rule that were focused on streamlining Medicaid and Children’s Health Insurance Program (CHIP) eligibility, enrollment, and timeliness standards are slated to be finalized in February 2024.

MSPs are state-run programs that help low-income Medicare enrollees pay their Medicare premiums and/or cost-sharing. In 2017, the Medicaid and CHIP Payment and Access Commission found that only about half of Medicare enrollees eligible for an MSP actually enrolled. CMS estimates that the rule will make Medicare coverage more affordable for 860,000 individuals by making it easier to enroll in an MSP.

This expert perspective provides a high-level overview of key provisions included in the “Streamlining Medicaid; Medicare Savings Program Eligibility Determination and Enrollment” final rule that will facilitate enrollment and retention of MSP coverage. While the final rule’s effective date is November 17, 2023, CMS delayed compliance dates for most provisions until April 1, 2026, to reflect states’ competing priorities in light of the “unwinding” of the Medicaid continuous coverage requirement.

Key Provisions of the Final Rule

For a summary of the August 31, 2022 proposed rule, please refer to the expert perspective CMS Proposed Rule on Medicaid and CHIP Eligibility, Enrollment, and Renewal.