CMS sets national dates for Medicaid enrollment compliance

The Centers for Medicare and Medicaid Services is cracking down on state Medicaid programs after determining that widespread problems with enrollment still haven’t been fixed.

Although the Medicaid unwinding process is essentially complete, CMS is not satisfied with its takeaways. Inappropriate disenrollments and applications backlogs skyrocketed when states resumed Medicaid eligibility checks in early 2023 after pausing them during the COVID-19 public health emergency, and CMS is concerned that some problems remain unresolved.

Related: CMS toughens Medicaid oversight after ‘unwinding’ mess

The agency is setting a new universal deadline of Dec. 31 for all states to submit information detailing the scope of their compliance with existing enrollment requirements and their plans to correct any deficiencies. CMS said in July that it would issue additional guidance on federal renewal requirements later in the year. 

States will need to be fully compliant with enrollment policies by a second universal deadline, Dec. 31, 2026, CMS said in its Friday guidance. 

“As a condition of CMS' continued non-enforcement of previously identified compliance issues, and to avoid more detailed and particularized requests for further action in other states, all states will be required to assess and demonstrate their compliance with certain key federal renewal requirements,” according to the informational bulletin.

Those requirements include:
•    States must attempt to conduct an automatic renewal for all beneficiaries using income data from other social programs, a process called “ex-parte renewals.” 
•    When ex-parte renewals can’t be completed, states are required to provide forms to beneficiaries and only ask them for the information needed to determine their eligibility.
•    States have to give enrollees a reasonable timeframe for returning enrollment forms, though that period depends on factors such as age, disability status and family status.
•    States need to ensure enrollees have the opportunity to submit their paperwork in a variety of modalities, including through the mail, online, on the phone and in person. 
•    State agencies are require to reconsider terminations that are made when certain beneficiaries don’t return their forms, as long as that information is submitted within 90 days of the termination.
•    States have to consider all bases for Medicaid eligibility before they deny an application or renewal.
•    When a beneficiary is found to be ineligible for Medicaid, states must determine whether that beneficiary is eligible for another insurance program, and must transfer their enrollment to that program in a timely manner if they qualify. 

“Because CMS identified areas of noncompliance with renewal requirements in nearly every state during unwinding, with many common areas of noncompliance across states, CMS believes a standardized process will support states to achieve compliance with all renewal requirements in the most timely and efficient manner,” the bulletin says.

States that were previously asked to submit mitigation plans are now required to complete their compliance assessment and plan “as a condition of CMS’ continued non-enforcement of the underlying compliance issues in those states.”

More than 25 million people were disenrolled from Medicaid and more 56 million had their coverage renewed, according to new data from KFF. Despite the mass disenrollments, about 10 million more people are now enrolled in Medicaid and the Children’s Health Insurance Program than in early 2020, KFF says.

CMS has signaled repeatedly that it’s paying closer attention to how states handle both enrollment renewals and the process of onboarding new enrollees. The new bulletin is the latest layer of pressure on states and the strongest sign yet that CMS is planning to punish transgressors. 

“We are glad to see CMS moving forward on ensuring that Medicaid renewal requirements are adhered to nationwide and in a transparent way,” said Joan Alker, research professor and executive director of the Georgetown University Center for Children and Families. 

CMS is requiring a written update every six months from states that are working to correct areas of noncompliance. That should include any information or documentation states deem necessary to demonstrate they’re coming into compliance, the bulletin says.

States that aren’t meeting milestones for their compliance plans or are at risk of missing the 2026 compliance deadline could be subject to additional information requests and more frequent reporting of their progress, according to the bulletin.

CMS is also going to continue reviewing state-submitted data and other available information and says it plans to follow up with all states if it identifies potential renewal compliance issues illuminated by the data. 

“The Medicaid unwinding process has laid bare that many problems exist and the stakes are high — families and people with disabilities who rely on Medicaid for their health insurance can’t afford to lose that coverage for procedural reasons,” Alker said. “We applaud CMS’ efforts to ensure that states are respecting the protections in place — which are there for a reason, which is to ensure that no one loses coverage when they remain eligible.”

The American Academy of Family Physicians said in an email that it supports CMS exercising its authorities granted by Congress to minimize unnecessary disenrollments and ensure compliance with other enrollment requirements.

AHIP, Medicaid Health Plans of America, the Association for Community Affiliated Plans and The National Association of Medicaid Directors did not immediately respond to requests for comment.