Aug, 30, 2024

CMS Issues Guidance on Renewal Timeliness Post-Unwinding

Patti Boozang and Kaylee O’Connor, Manatt Health

On August 29, the Centers for Medicare & Medicaid Services (CMS) released a CMCS Informational Bulletin (CIB) and accompanying slide deck to support states facing renewal backlogs. With this guidance, CMS is providing states additional time—until December 31, 2025—to complete Medicaid and Children’s Health Insurance Program (CHIP) eligibility renewals, address persistent backlogs in processing redeterminations, and achieve compliance with federal renewal timeliness requirements.

Timeline for Processing and Distributing Renewals

Through the CIB, CMS gives states the ability to continue to delay timely processing[1] of certain renewals until December 31, 2025, specifically:

  • Unwinding-related renewals: States must make a final eligibility determination for all individuals who were enrolled in Medicaid and CHIP when the Medicaid continuous coverage requirement expired on March 31, 2023 by December 31, 2025.
  • Non-unwinding-related renewals: States may also continue to delay and/or redistribute non-unwinding-related renewals[2] through December 31, 2025 for the purpose of ensuring a more even distribution of redeterminations that is sustainable in future years.
  • Beginning with renewals initiated January 1, 2026: States must “return to regular business” and ensure timely processing, consistent with federal regulations and state timelines.

CMS provides specific conditions to which states must adhere in developing their plans for redistributing renewals (e.g., a state may not shorten an enrollee’s eligibility period). States must document their approach in their internal unwinding plans,[3] and inform CMS (CMSUnwindingSupport@cms.hhs.gov) if their unwinding timelines have changed. Further, CMS directs states that are not on track to comply with the timelines outlined in the guidance to reach out to CMS as soon as possible, noting that non-compliance may result in a corrective action plan.

State Options for Processing Renewals More Than Six Months Old

CMS provides states with two options (and flexibility to propose alternative approaches) for processing renewals that have been pending for more than six months, given states generally should not rely on information subject to change that is more than six months old to make an accurate determination of eligibility for a new 12-month eligibility period.[4] States with renewals that have been pending for more than six months will need to select either of the following approaches:

  1. Renew for the Remainder of the Eligibility Period: Rely on existing information in the returned renewal form/documentation to renew eligibility through the remainder of the 12-month eligibility period (thereby maintaining the enrollee’s original renewal cycle). If this option is not practical given the next scheduled renewal is scheduled shortly thereafter, then states should instead utilize the option below. States may not use this approach to disenroll an individual from Medicaid or CHIP; should an enrollee appear ineligible, states must instead pursue the option below.
  2. Re-initiate Pending Renewal: Conduct an ex parte renewal (and send a renewal form if information is insufficient to reestablish eligibility); and, for individuals determined eligible, provide a new 12-month eligibility period following the determination based on the new information obtained.

Companion Slide Deck

Finally, CMS provides a short set of companion slides that summarize the CIB and offer additional guidance to states to support compliance with federal regulations on timely processing of Medicaid and CHIP eligibility renewals, including time-limited strategies and ongoing practices for timely renewal processing.

[1] This authority exists under 42 C.F.R. §§ 435.912(e) and 457.340(d).

[2] A non-unwinding-related renewal refers to a second or subsequent renewal following the end of the Medicaid continuous coverage requirement, or a first renewal for an individual who enrolled after March 31, 2023.

[3] States must make their plans available to CMS upon request or, as needed, for audit purposes.

[4] Also see CMS, “Ex Parte Renewal: Strategies to Maximize Automation, Increase Renewal Rates, and Support Unwinding Efforts,” October 20, 2022.