The Affordable Care Act (ACA) envisions highly automated renewals for Medicaid and CHIP. With new eligibility systems capable of retrieving personal eligibility-related data from trusted sources, such as the state’s wage database, agencies should be able to renew coverage for most enrollees without requiring them to complete forms or submit paperwork. But first, state agencies need to collect new information regarding tax-filing status and access to affordable employer-based minimum essential coverage. Just like new applications, renewals in Medicaid and CHIP will be based on the MAGI-based rules for counting income and household size and must coordinate eligibility across the continuum of coverage, including financial assistance to purchase marketplace plans.
In this new super short brief, Martha Heberlein and I describe the Medicaid and CHIP renewal process going forward. But more importantly, we discuss why the first round of MAGI-based renewals will be more involved, and how the ACA includes important protections for some enrollees, including children who lose Medicaid eligibility at renewal due strictly to the change in eligibility rules.
Over the past decade, states have been working to improve retention rates in Medicaid and CHIP, relying on technology to streamline the renewal process. Some states like Louisiana have gotten it down to a science – less than 1% of children in the Bayou state lose coverage at renewal due to procedural or paperwork reasons. These fast-track processes that have been broadly adopted by the ACA focus on using data to automatically renew coverage, offering multiple ways to renew (online, over the phone, etc.) and reducing the length of forms and paperwork needed to verify eligibility.
Before fully implementing data-driven renewals, states must collect additional information, and hence the HHS model form for first-time MAGI renewals. While HHS created the form using form design and plain language experts, and refined it after consumer-testing, it’s still 13 pages long (although 4 pages are supplements that may not need to be completed). Experience in Medicaid and CHIP have shown a correlation between reducing paperwork and increased retention. Therefore, longer forms and more information could translate into more churn at renewal as states transition to the new way of doing things.
States have several tools for boosting retention. My colleague, Martha Heberlein, will write about one policy option – delaying renewals to get systems in prime shape – in the second blog of this renewal series. Additionally, states need to be prepared to send several renewal reminders with clear instructions on how to maintain coverage. They should also boost consumer assistance to help enrollees through the first MAGI-based renewal. And the good news is these activities qualify for a 75% federal match as I noted in this blog earlier this week.
Over the past decade, our country has achieved historic low rates of uninsured children as a direct result of the effectiveness of Medicaid and CHIP. As states turn their attention from open enrollment to the first round of MAGI-based renewals, great care needs to be taken to make sure we don’t risk the gains we have made in covering kids.