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If the separate CHIP is not part of the single State agency, then as described at proposed 435.1200(b)(4)(i), the Medicaid and Under Medicaid, premiums are authorized under sections 1902(a)(14), 1916, and 1916A of the Act, and implementing regulations at 42 CFR 447.50 through 447.57. At proposed 435.1200(e)(1)(i), we would require that in a State that operates a separate CHIP, when the Medicaid agency determines an individual to be ineligible for Medicaid, it must also determine whether the individual is eligible for CHIP using information available to the agency. In Florida, Medicaid programs are also provided for disabled individuals, foster children, and for non-citizens in emergency health situations. We believe the longer timeframe is appropriate because some individuals with disabilities may need more time to gather documentation related to their disability determination and since States have up to 90 calendar days to make a final determination of eligibility on disability-based applications, the additional time will not undermine States' ability to make a timely determination. Additionally, PERM eligibility reviews in the FYs 2019, 2020, and 2021 cycles found that insufficient documentation was a leading cause of eligibility errors.[64]. (d) While the federal regulations prohibit states from charging certain enrollees or charging any enrollees for certain services, each state has the power to establish out-of-pocket expenses for enrollees. Greater reliance on electronic verifications has reduced the need for individuals to find and submit, and for eligibility workers to review, copies of paper documentation, decreasing burden on both States and individuals and increasing program integrity. States would not be required to establish the same reasonable compatibility threshold for income and resources, and may apply different reasonable compatibility thresholds for different eligibility groups, provided that the State has a reasonable rationale for doing so. Medicaid permits disenrollment for failure to pay premiums is at 447.55(b)(2), but does not permit premium lock-out periods. Accessed online on July 19, 2022 at We estimate that it would take each State 6 hours to update their notices to inform beneficiaries of the newly established timeframes within which they must return requested additional information in order for the State to process their redeterminations. Start Printed Page 54851 While almost all States adopt at least one of the optional processes for renewals of non-MAGI beneficiaries,[50] These regulatory changes were issued by CMS in a November 2016 final rule titled, Medicaid and Children's Health Insurance Programs: Eligibility Notices, Fair Hearing and Appeal Processes for Medicaid and Other Provisions Related to Eligibility and Enrollment for Medicaid and CHIP (81 FR 86453, November 30, 2016) (referred to hereafter as the 2016 eligibility and enrollment final rule). 01-22. In Part A buy-in States with a 1634 agreement, once the State receives the automated Part B buy-in enrollment from CMS for an SSI recipient who lacks a sufficient work history for premium-free Part A, under proposed 435.909(b)(1)(ii) the State would enroll the individual in the mandatory SSI group, deem the individual eligible for the QMB group, and effectuate enrollment in Medicare Part A through the buy-in agreement. A State may not, under this section, impose a waiting period before enrolling an eligible individual who has, but is not enrolled in, group health plan coverage into CHIP premium assistance coverage. And it would permit States with greater capacity to implement new system changes to immediately adopt simplifications like removal of the requirement to apply for other benefits as a condition of Medicaid eligibility. We recognize this proposal would represent a significant change for a number of States and could present some administrative challenges to implement. Specifically, 12 States place an annual dollar limit on at least one CHIP benefit, and six States place a lifetime dollar limit on at least one benefit. 12. With passage of the ACA, coverage in a QHP through the Exchanges became available, and families may now qualify for premium tax credits to purchase coverage from the Exchange for their children while they wait for CHIP coverage during a waiting period. After the medical exam, the hospital determined that emergency services were not needed. We are also proposing to revise 435.952(e)(4) to require States to develop a verification process to determine the cash surrender value of life insurance policies over $1,500. The aggregate economic impact of this proposed rule is estimated to be $61.93 billion (in real FY 2023 dollars) over 5 years. Start Printed Page 54853 These records, which are critical to demonstrating that States are providing the proper amount of medical assistance to eligible individuals, include: Neither the statute nor current regulations specify how long Medicaid records must be maintained. Foster, Leslie. Bucks County Playhouse will present Hirschfelds Broadway, a new multi-media presentation illustrating and celebrating some of the most loved moments in American theater. Section 1860D-14(a)(3)(C)(i) of the Act, added by section 116 of MIPPA, excludes in-kind support and maintenance as countable income for LIS determinations. The current provision prohibits States from using the timeliness standards as a waiting period for new applicants or as a reason for denying eligibility because it is not determined within the required timeframe. Montana Medicaid Application:https://apply.mt.gov/. We assumed that this would increase overall enrollment by about 0.5 percent, or about 410,000 person-year equivalents by 2027. Requirements at 457.810 apply the same 90-day maximum and Federal exceptions to waiting periods for CHIP premium assistance programs. We propose that the application timeliness standards provided under 435.912(c)(3) would apply to redeterminations initiated during the 90-day reconsideration period proposed at 435.919(d). The agency must inform individuals of the timeliness standards adopted in accordance with this section. We anticipate this proposal would be a change for 10 States in their process for verifying the cash surrender value of life insurance policies over $1,500. Requiring a single affordable annual payment may improve retention, reduce disenrollment rates, and simplify program administration, for example, by reducing the cost of billing, collecting and processing premium payments. Section 435.911(e)(4) would require States to refrain from requesting information from individuals already provided through leads data unless information available to the agency is not reasonably compatible with information provided by or on behalf of the individual, while 435.911(e)(5) requires States to accept information provided through the leads data relating to a criterion of eligibility without further verification. To address the current situation where redeterminations remain unprocessed for several months following the end of a beneficiary's eligibility period due to the beneficiary failing to return needed information to the State, these proposed amendments would require States to establish timeliness standards for both beneficiaries to return requested information to the State, as well as for the State to complete a redetermination of eligibility when the beneficiary returns information too late to process before the end of the eligibility period. As with dividend and interest income, 435.952(e)(2)(ii) clarifies that States must request documentation prior to making an initial determination denying eligibility if they have information that is not reasonably compatible with the applicant's attestation in accordance with 435.952(c)(2). A regulatory impact analysis (RIA) must be prepared for major rules with significant regulatory action(s) or with economically significant effects ($100 million or more in any 1 year). [757677] To obtain copies of the supporting statement and any related forms for the proposed collections discussed above, please visit the CMS website at Our proposed amendments would require BHP States to revise their BHP Blueprints to remove the premium lock-out period. During this 90-day period, if a beneficiary returns the requested information, the agency would be required to redetermine the individual's eligibility without requiring a new application. are for better understanding how a document is structured but 3. It is a CMS priority to ensure that renewals of eligibility and transitions between coverage programs occur in an orderly process that minimizes beneficiary burden and promotes continuity of coverage. 17. (iv)(A) When an individual must provide documentation of the cash surrender value of a life insurance policy, the agency must assist the individual with obtaining this information and documentation by requesting that the individual provide If you are using public inspection listings for legal research, you Start Printed Page 54770 documents in the last year, 1460 Michigan Department of Community Health Washington, DC: Urban Institute. We seek comment on whether an effective date of 30 days following publication would be appropriate when combined with a later date for compliance for most provisions. The traditional Medicaid coverage covers low-income families, seniors, and those with disabilities, at no cost; The Dr. Dynasaur program offers free to low-cost health coverage for children and pregnant women. save Available at Excluding those with Medicaid and assuming the two groups are mutually exclusive, 17 percent of low-income beneficiaries without Medicaid had supplemental coverage. We anticipate a reduction in administrative burden for States resulting from the proposed elimination of the requirement to apply for other benefits outlined in the preamble of this proposed rule. from critical unwinding-related activities, then a compliance date following the unwinding period may be preferred. , CMS issued implementing regulations titled Medicaid program; Eligibility Changes Under the Affordable Care Act of 2010 final rule, (77 FR 17144) (referred to hereafter as the 2012 eligibility final rule), and the Medicaid and Children's Health Insurance Programs: Essential Health Benefits in Alternative Benefit Plans, Eligibility Notices, Fair Hearing and Appeal Processes, and Premiums and Cost Sharing; Exchanges: Eligibility and Enrollment final rule titled in July 2013 (78 FR 42160) (referred to hereafter County Assistance Office staff will determine who are mandatory or optional budget group members in the Medical Assistance application based upon household relationships and individual needs for Medical Assistance. A., Mitnik, G. L., Iafolla, T. J., & Vargas, C. M. (2017). Under this policy, Part A buy-in States can determine an individual eligible for QMB status, and thus for their Part A premiums to be paid, if they are enrolled in Part B but not yet entitled to Part A. Medicaid Financial Eligibility for Seniors and People with Disabilities: Findings from a 50-State Survey. Most individuals enrolled in Medicare qualify for Part A without paying a premium (premium-free Part A). We also propose to expand the scope of paragraph (c) of 435.1200, which provides for the provision of Medicaid to individuals determined eligible by another insurance affordability program. We believe that the separate CHIP agency is already required to provide similar information to families of children that may potentially be eligible for Medicaid on a non-MAGI basis in 457.350(e) (redesignated as proposed 457.350(f)). Unlike in Part A buy-in States, individuals determined eligible for the mandatory SSI or 209(b) group in group payer States who are enrolled in Part B pursuant to the State's buy-in agreement will not necessarily satisfy the eligibility requirement for the QMB group that the individual be entitled to Part A. For individuals with a disability that have not been qualified for SSI, there are still options to qualify for Medicaid. Streamlining the Medicaid, Childrens Health Insurance II. https://www.medicarerights.org/pdf/Part-A-Buy-In-Analysis.pdf. http://www.regulations.gov. Certain health situations can also make you eligible. We believe this would also promote program integrity. Available at We also seek comment on the efficacy of the requirement to send a notice to a beneficiary's address on file to ensure that initial piece of returned mail was not incorrectly returned, and on the efficacy of the requirement to conduct at least two outreach attempts to the beneficiary using a modality other than mail. Of States that do not automatically enroll these individuals in the QMB group, we assumed that about 20 percent of States would use the option provided in this proposed rule, and that about 50 percent of this population would be enrolled in the QMB group as a result. The agency must make a redetermination of eligibility for all Medicaid beneficiaries without requiring information from the individual if able to do so based on reliable information contained in the individual's account or other more current information available to the agency, including but not limited to information through any data bases accessed by the agency under 435.948, 435.949, and 435.956. In the March 23, 2012 The requirement applies to adults only, which equates to approximately 46,000,000 Medicaid applicants. 81. States must renew eligibility for all Medicaid beneficiaries without requiring information from the individual if able to do so consistent with regulations at 435.916(a)(2) and (b). Does it raise enough questions? https://apps.sd.gov/ss36snap/web/Portal/Default.aspx. We are proposing a 30-day reconsideration period at application, rather than a 90-day reconsideration period similar to the 90-day period proposed at redetermination, because we believe applicants will generally be expecting a communication from the State regarding the status of the submitted application and will be less likely than current beneficiaries to miss requests for additional information. The FPL or a percentage of the FPL is used to determine income eligibility for Medicaid. These include family size, need for long-term care, ability level, and if you receive Medicare. OHP helps Oregon low-income Oregon residents with the costs of doctors visits, prescription medications, mental healthcare, dental care, and addiction treatment. New Yorkers who apply for Medicaid benefits must have income that is determined at or below poverty level. You must be a state resident and meet the financial income requirement. This program covers the cost of medical services for people with low to limited incomes. better and aid in comparing the online edition to the print edition. These tools are designed to help you understand the official document Under proposed 435.952(e)(4)(i)(A), if an individual attests to having a life insurance policy with a face value in excess of $1,500, consistent with current regulations at 435.948, States may accept the attested cash surrender value. Recent expansions in eligibility requirements allow more people to qualify. $2,277. Therefore, if there are about 400,000 new LIS applicants In order to address the barriers to accessing MSP coverage, in 2008 Congress enacted the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA, Pub. We estimate that it would take a Management Analyst in each State 0.0083 hr/notice at $96.66/hr to program the sending of these extra notices for a total of 106,832 hours (0.0083 hr 12,871,377 beneficiaries) at a cost of $10,326,381 (106,832 hr $96.66/hr). Discrepancies between a State's projections and the cost of services actually received inevitably will exist. who would In addition to the sources of uncertainty described previously, there are other reasons the actual impacts of these provisions may differ from the estimates. Because 10 States (about 20 percent of all States) do not have asset tests and do not require documentation to complete an eligibility determination or redetermination at the State Medicaid agency, we expect the savings from the self-attestation proposals would only apply to approximately 8.4 million individuals (80 percent of 11 million applications/renewals[84] (v) The advance notice that must be provided to beneficiaries in accordance with 431.211, 431.213, and 431.214 of this subchapter when the agency makes a determination resulting in termination or other action as defined in 431.201 of this subchapter. To estimate the impacts this proposed rule would have on Marketplace expenditures, we started by calculating the cost of care and Federal subsidy payments for different households shifting from Marketplace coverage to Medicaid and CHIP. If the third-party information would result in an adverse action, the agency must contact the beneficiary and request additional information to verify or dispute the information. Since 1965, Medicaid has been a cornerstone of America's health care system. (ii) The electronic account and any information or other documentation received from another insurance affordability program in accordance with 435.1200(c) and (d) of this subchapter. You must also meet another requirement: you have children, are a person who is 65 years or older, be blind or permanently disabled, or pregnant. Prior to providing such notice or additional child health assistance or pregnancy-related assistance or lowering premium or cost sharing charges, the State may verify third-party information with the enrollee; the State may not terminate the enrollee's coverage if the enrollee does not respond to the State's request for additional or pregnancy-related assistance under this paragraph. We believe starting the 30-day period from the date the State sends the form, instead of the date on the form, will ensure beneficiaries do not lose time to respond if the form is postmarked or sent after it is dated. We may earn money when you click on our links. https://www.medicaid.gov/federal-policy-guidance/downloads/cib11012021.pdf. Similarly, we propose to require the Medicaid agency to ensure that an individual determined eligible for Medicaid by a separate CHIP agency also receives a combined notice. While many States limit specific benefits to an annual or lifetime dollar amount, currently, no State imposes an aggregate annual or lifetime limit on all CHIP benefits. beneficiary's enrollment, or moving the beneficiary from managed care to fee-for-service Medicaid. If you have questions about appeals, call the Michigan Office of Administrative Hearings and Rules for the Department of Health and Human Services at 1-800-648-3397. of this preamble, every State with separate programs for Medicaid, CHIP, and BHP, and many States with a State-based Marketplace utilize a single eligibility system or shared eligibility service. The general requirements for coordination are described at 435.1200(b). Taking into account the 50 percent Federal contribution to Medicaid and CHIP program administration, the estimated State cost would be $1,327. (B) May begin a new eligibility period, consistent paragraph (e)(2) of this section, if the State has sufficient information available to it to renew eligibility with respect to all eligibility criteria without requiring additional information from the enrollee. Accessibility and availability of records. [72] We considered allowing States, which have not yet transitioned their enrollee records into an electronic format, to continue to maintain a paper-based record keeping system. (2) May include expenses for services that the agency has determined are reasonably constant and predictable, including, but not limited to, services identified in a person-centered service plan developed pursuant to 441.301(b)(1)(i), 441.468(a)(1), 441.540(b)(5), or 441.725 and expenses for prescription drugs, projected to the end of the budget period at the Medicaid reimbursement rate. The options for the Medicaid agency to accept a CHIP eligibility determination and continue to comply with Medicaid single State agency responsibilities are discussed in section II.B.5 of the Medicaid preamble. Comme Des Garcons Shirt Deconstructed Cotton And Wool Shirt - Blue. Thus, actual savings could be greater or lesser than estimated here. (1) For each individual determined CHIP eligible in accordance with paragraph (b)(2) of this section, the State must. (vii) All notices provided to the applicant or enrollee in accordance with 457.340(e) and 457.1180; and, (viii) All records pertaining to any State reviews requested by, or on behalf of, the applicant or enrollee, including each request submitted and the date of such request, the complete record of the review decision, as described in subpart K of this part, and the final administrative action taken by the agency following the review decision and date of such action; and. Pursuant to 435.952(c), States may also seek information from the individual if the State has other information that is not reasonably compatible[27] (1) The State must limit any requests for additional information under this section to information relating to change in circumstances which may impact the enrollee's eligibility. As background, the QMB eligibility group covers Part A premiums for individuals who do not qualify for premium-free Part A. Adding new paragraphs (c)(1)(i)(A)( 2) and ( Medicaid financial eligibility for seniors and people with disabilities: Findings from a 50-State survey, p. 19-20. To promote accountability and a consistent, high quality consumer experience among States and between insurance affordability programs, the timeliness and performance standards included in the State plan must address. Applying for WIC. or to maintain current coordination requirements, such that BHPs are required only to evaluate potential eligibility for Medicaid and CHIP and to accept determinations of potential BHP eligibility made by a Medicaid or separate CHIP agency. Current 435.916(f) (redesignated at proposed 435.916(d)) requires the agency, when it determines that an individual is no longer eligible on the basis upon which he or she has been receiving coverage, to consider eligibility on all bases prior to completing a determination of ineligibility for Medicaid. In West Virginia, its up to the Department of Health and Human Resources to determine your Medicaid eligibility. To effectuate this option, we propose to add the State agencies that administer the separate CHIP and BHP programs to the list of entities in 431.10(c)(1)(i)(A) to which the Medicaid agency may delegate authority to make determinations of Medicaid eligibility. In this situation, the agency would not provide the more beneficial coverage but would instead continue to provide the less beneficial coverage for which eligibility was already established. At 87 FR 25114 through 25115 of the proposed rule, we noted that this time limit would reduce burden on providers, help State Medicaid programs and the Medicare program run more efficiently, be consistent with a legal ruling in favor of States in at least one Federal court, and not harm Medicaid beneficiaries since Medicaid would have covered any medical costs the beneficiary incurred for periods in the past. Limitations. Under section 1860D-14(a)(3)(C)(i) of the Act, income shall be determined in the manner described in section 1905(p)(1)(B) of the Act, without regard to the application of section 1902(r)(2) of the Act and except that support and maintenance furnished in kind shall not be counted as income.

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