Nov, 15, 2024

CMS Releases Guidance on Optional Long-Term Use of Unwinding-Related Section 1902(e)(14) Waivers

Patti Boozang, Kinda Serafi, and Kaylee O’Connor, Manatt Health

On November 14, 2024, the Centers for Medicare & Medicaid Services (CMS) released its second installment in its series of Medicaid and CHIP guidance[1] intended to support state efforts to verify eligibility and conduct renewals in compliance with federal Medicaid and Children’s Health Insurance Program (CHIP) requirements. The latest CMCS Informational Bulletin (CIB) and accompanying slide deck address the continued use of unwinding-related section 1902(e)(14) waivers[2] beyond the previously established expiration date of June 30, 2025. CMS points to existing federal authority for states to continue permanently at state option in a materially similar way over half of the unwinding-related section 1902(e)(14) waivers. As a result of this guidance, the flexibilities that had the biggest impact on increasing ex parte rates and maintaining coverage for eligible individuals are now permanently available for states.

According to the guidance, states are newly permitted to continue under Medicaid or CHIP authority the following strategies to:

  • Use gross income determinations from the Supplemental Nutrition Assistance Program (SNAP)[3] to verify Modified Adjusted Gross Income (MAGI)-based income at application and/or at renewal (the “SNAP Strategy”).
  • Complete ex parte renewals for MAGI and non-MAGI enrollees when no data sources return income information if: the enrollee had a previously-verified attestation of income between $0 and 100 percent of the federal poverty level; the state checks all available income data sources and no information is received; and the state takes steps to confirm continued state residency[4] (the “$0 Income Strategy” and the “100 Percent Income Strategy”).
  • Assume no change in resources when no information is returned or there is no response from the state’s asset verification system (AVS) within a reasonable timeframe (the “AVS Strategy”).
  • Disregard otherwise countable income and/or resources in making non-MAGI eligibility determinations (the “Streamlining Asset Determinations Strategy”).
  • Make a reasonable determination of the types of income and assets that are highly likely to remain stable (or decrease in value) in conducting ex parte renewals (the “Stable Income and Asset Strategy”).
  • Permit managed care organizations (MCOs) to conduct outreach and assist enrollees with completing and submitting renewal forms, provided MCOs do not provide choice counseling or sign the renewal form (the “MCO Renewal Support Strategy”).
  • Permit qualified entities to make presumptive eligibility (PE) determinations on a MAGI-basis for individuals not enrolled in Medicaid or CHIP, and treat renewal forms returned during the reconsideration period as Medicaid/CHIP applications to extend the PE period (the “State Agency/Other Qualified Entities Using PE Strategy”).

 

In addition, states are required by CMS’s Streamlining the Medicaid, Children’s Health Insurance Program, and Basic Health Program Application, Eligibility Determination, Enrollment, and Renewal Processes Final Rule to implement several section 1902(e)(14) waivers. For the full list of section 1902(e)(14) waivers—including those that states must sunset after June 2025 (except in limited circumstances based on state-specific needs)—and additional steps that states must take to continue these strategies, see the appendix chart in CMS’s CIB.

 

[1] CMS has indicated that forthcoming guidance will provide “clarity on renewal requirements across several key topics, including income verification, ex parte renewals, and requirements related to renewal forms”. For more on CMS’s September 2024 guidance, see this State Health & Value Strategies summary.

[2] Section 1902(e)(14)(A) of the Social Security Act allows for waivers “as are necessary to ensure that states establish income and eligibility determination systems that protect beneficiaries.”

[3] States that wish to use data from other human services programs, such as the Temporary Assistance for Needy Families (TANF), or that are interested in using SNAP gross income for non-MAGI populations, must make the case to CMS through an analysis.

[4] For more information, see the November 14, 2024, Office of the Assistant Secretary for Planning and Evaluation (ASPE) report.