Medicaid Rule Improving Access for Children

Situation

Centers for Medicare & Medicaid Services (CMS), HHS published 09/07/2022 A Proposed Rule. According to the applicants, the proposed rule organizes the application, eligibility determination, enrollment, and Medicaid renewal processes. The applicants believe there is a lack of support for children who need health insurance, and the new regulation would simplify the processes for enrolling them in the program. Strengthening existing processes related to application processing and enrollment requires expansion due to the expiration of the ten-year statute of limitations of the first rules (Serafi & Dutton, 2022). The lack of full coverage for all children who require assistance does force one to look for ways to reconcile the availability of health insurance and ways to purchase it for vulnerable populations.

Background

The changes planned to be implemented in the organization of Medicaid application processes will affect children to facilitate the processing of their claims. According to the rule provided, health insurance access extensions from 2010 through 2022 allow nearly millions to receive assistance (Centers for Medicare & Medicaid Services (CMS), HHS, 2022). With the Children’s Health Insurance Program (CHIP), Medicaid is a companion to many children with serious illnesses. The integration of this rule into practice is due to the large number of children not enrolled in any program. Given the impact of COVID-19, the critical vulnerability of the pediatric population becomes even more pronounced as vaccines and services are developed for adults. In addition, the lack of rules governing the scope and format of applications puts children and their parents/guardians in a precarious state because they need to get all the information promptly.

Assessment

CMS’s proposed recommendation could significantly improve the current state and procedures for Medicaid enrollment. The rule would reduce administrative burdens: individuals with access to coverage have difficulty navigating the application process because it is cumbersome. Orris (2022) points out that about a quarter of people do not get coverage because the processes are too long and need to be more user-friendly. While this is done to select program participants carefully, it is still possible to achieve much more coverage with CMS expansion and objectively simplify the administrative burdens on people.

Adopting the rule could lead to more recognizable eligibility criteria, and people would not have to undergo repeated vetting and proof. The American Hospital Association (AHA) comes to a similar view and supports flexibility for states to expand income eligibility (2022). In addition, the AHA states that the best practice would be to increase the access period for filing and processing claims – it would be easier for people to get insurance because they would have time to weigh the pros and cons. The proposed CMS rule is promising and necessary for a variety of reasons. It would help structure enrollment processes, streamline eligibility renewals, and ease the administrative burden for potential users.

Recommendation

Thus, the proposed healthcare provider that CMS formed in July of this year could significantly improve health coverage. First and foremost, the adoption of improvements and streamlining of Medicaid application and processing processes and subsequent acceptance is recommended. Second, the best recommendation is to renew Medicaid membership when the criteria are met automatically and to extend the period to confirm this eligibility. Third, adopting this provision could dramatically change the frequency with which applications are accepted and approved because potential participants would be selected with greater care. CMS’s proposal could lead to a better distribution of health coverage to children and other vulnerable populations.

References

American Hospital Association. (2022). AHA comments on CMS’ proposed rule to streamline the eligibility, enrollment, and renewal process for Medicaid, Chip. AHA. Web.

Centers for Medicare & Medicaid Services (CMS), HHS. (2022). Streamlining the Medicaid, children’s health insurance program, and basic health program application, eligibility determination, enrollment, and renewal processes. Federal Register. Web.

Orris, A. (2022). The newly proposed rule would help kids, seniors, and others get and stay enrolled in Medicaid and CHIP. Center on Budget and Policy Priorities. Web.

Serafi, K., & Dutton, M. (2022, September 16). CMS proposed rules on Medicaid and CHIP eligibility, enrollment, and renewal. State Health and Value Strategies. Web.

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StudyCorgi. "Medicaid Rule Improving Access for Children." April 6, 2024. https://studycorgi.com/medicaid-rule-improving-access-for-children/.

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StudyCorgi. 2024. "Medicaid Rule Improving Access for Children." April 6, 2024. https://studycorgi.com/medicaid-rule-improving-access-for-children/.

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