Ensuring Compliance with Federal Renewal Requirements
Patricia Boozang, Kinda Serafi and Kaylee O’Connor, Manatt Health
The recently enacted Consolidated Appropriations Act, 2023 (CAA) provides enhanced federal funding to states to support unwinding, provided that they conduct eligibility redeterminations and renewals in compliance with federal regulatory requirements at 42 CFR § 435.916 and meet certain additional conditions. States that are not able to fully comply with federal regulatory renewal requirements may still access the enhanced federal match and/or avoid corrective action by adopting Centers for Medicare & Medicaid Services (CMS)-approved mitigation strategies.
State Health and Value Strategies hosted a working session for state officials responsible for unwinding the Medicaid continuous coverage guarantee, or for operationalizing, refining, and overseeing E&E processes, including redeterminations/renewals and systems changes. During the session, presenters (1) provided a brief overview of this diagnostic assessment tool that states can use to assess compliance with federal renewal requirements, (2) discussed common mitigation areas, such as the inability to conduct ex parte renewals for non-Modified Adjusted Gross Income (non-MAGI) enrollees, or no online renewal capabilities, and (3) offered mitigation strategies to correct non-compliance and promote continuity of coverage and care during the unwinding.
On December 6, the Centers for Medicare & Medicaid Services published and made effective an interim final rule (IFR) with comment period regarding states’ ongoing unwinding efforts to redetermine eligibility for all Medicaid enrollees nationwide. This expert perspective summarizes the IFR, which interprets and implements the state reporting requirements and CMS enforcement authorities that Congress enacted last winter in the Consolidated Appropriations Act of 2023.
The 11th annual open enrollment period (OEP) is underway, providing consumers with an opportunity to enroll in health coverage for plan year 2024 through the Affordable Care Act Marketplaces. To support consumers during this OEP, State-Based Marketplaces (SBMs) are innovating to make health coverage more affordable and easier for consumers to enroll. This expert perspective highlights new initiatives being implemented by SBMs during the plan year 2024 OEP, including establishing or improving state subsidy programs to reduce out-of-pocket costs, expanding coverage for undocumented populations, or implementing policies to improve the enrollment process.
As the unwinding of the Medicaid continuous coverage requirement continues, both states and the federal government are tracking and monitoring the impacts of the resumption of eligibility redeterminations and disenrollments. Given the time-lags and caveats of CMS data, many states are publishing their own state data dashboards. To date, 46 states (including the District of Columbia) have released unwinding data in either an interactive dashboard or static pdf format, or are making public their required CMS Monthly Unwinding Data reports. This expert perspective includes an interactive map with links to state reporting, as well as a table tracking the unwinding indicators and disaggregated data that states are reporting on. SHVS will continue to update this EP as more states publish their unwinding data.