By The Centers for Medicare and Medicaid Services (CMS) issued a stern warning to all 50 states regarding the improper loss of health coverage among children enrolled in Medicaid and the Children’s Health Insurance Program (CHIP).
Eligibility System Issues
CMS has instructed all states to assess whether eligibility system problems are leading to the unwarranted termination of coverage for eligible individuals, particularly children. Immediate action is required to rectify these issues and reinstate coverage, according to the regulator.
Post-Waiver Resumption
Following the conclusion of pandemic-era waivers that temporarily modified Medicaid and CHIP eligibility requirements, states have returned to their regular enrollment review procedures. Regrettably, since the expiration of these waivers, over 5.5 million individuals have been disenrolled from Medicaid, as reported by the health policy nonprofit KFF.
Flawed Eligibility Systems
CMS has identified a significant concern with the programming of eligibility systems in several states. Currently, automatic renewals are being processed at the family level instead of assessing each individual member separately, even though different family members may have distinct eligibility criteria. Notably, children often have higher eligibility thresholds and may still qualify for Medicaid or CHIP, even if their parents no longer meet the requirements.
It is imperative that states promptly address these issues to safeguard the health coverage of children and ensure that eligible individuals are not wrongfully deprived of the benefits they are entitled to.
Comments