New Standards for Medicaid and CMS Enforcement of State Compliance With Reporting and Federal Medicaid Renewal

The post-Covid increase in Medicaid enrollment with relaxed standards has come to a close as the world returns to normal.  However, the Medicaid disenrollment process should be an orderly and strategic one. Efforts earlier in the year were aimed at state compliance.  However, the Interim Final Rule promulgated by the federal government amped up the enforcement requirements against the states. This unwinding of continuous enrollment had already begun after the Covid public health emergency was officially, and legally, ended by the federal government. The Center for Medicaid and Medicare Services is enforcing standards on the disenrollment by states of Medicaid beneficiaries.  Lack of current compliance as to reporting obligations and improper disenrollment procedures will lead to penalization against the states.

Acting too strongly, states will disenroll Medicaid recipients in violation of federal rules.  Acting too leniently, and states will have swollen Medicaid rolls that they cannot afford to fund. Medicaid disenrollment, especially by “red states” disinclined to pay for large Medicaid populations, has been described as a wave hitting the healthcare sector.

The federal government via the Center for Medicaid and Medicare Services published an Interim Final Rule in the code of federal regulations governing this process.  This federal administrative regulation took effect immediately, although there remains a notice and comment period thereafter that may shape the final law.

Millions of Medicaid beneficiaries were disenrolled in 2023 starting in April with the end of the COVID-19 pandemic.  Some or many of those persons may obtain coverage elsewhere, but there remains an ongoing detriment to persons foregoing preventative care, not getting access to needed health care services, and thus an increase in emergency department visits and increased morbidity and mortality in general.

There are potential consequences to the states for non-compliance with current disenrollment standards.  Procedural issues have resulted in the majority of disenrollments, such as failure to keep one’s address and employment information current, rather than substantive reasons for denials and disenrollments due to actual ineligibility.

The Interim Final Rule is designed to continue the federal and state collaboration on state efforts to comply with disenrollment mandates – before punitive and sanctioning action is taken by the federal government.

• Introduction to federal regulatory Process and comment rulemaking
• What is an Interim Final Rule and how does it apply here?
• Keeping people covered as states restart routine Medicaid renewals
• Returning to regular Medicaid renewals:  monitoring, oversight, and requiring states to meet federal requirements
• Medicaid continuous enrollment condition:  unwinding at a glance
• What can you do?
• Top five FAQs:  Frequently Asked Questions to Support the Return to Normal Eligibility Operations
• The Oregon experience; what we can learn from one state’s efforts
• Conclusion and summary

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