The coronavirus pandemic is a stark reminder of the critical role that Medicaid and CHIP play in assuring the health of Americans, particularly during health emergencies, natural disasters, and economic downturns. Yesterday, CMS released a helpful FAQ relating to flexibilities Medicaid and CHIP agencies have in responding to this public health emergency. In particular, it notes a several options related to Medicaid and CHIP eligibility and enrollment.

• States may expand hospital presumptive eligibility to non-MAGI groups. The ACA requires states to allow hospitals to make presumptive eligibility determinations for MAGI groups, including children, pregnant women, parent/caretakers, and former foster youth, as well as expansion adults in expansion states and for individuals eligible for family planning services or needing treatment for breast and cervical cancer (if covered by the state). States may also allow hospitals to make presumptive determinations for seniors, individuals eligible due to blindness or disability, and for Section 1115 demonstration populations.
• Medicaid agencies may be excused from meeting application processing timeliness standards due to administrative or other emergency beyond the agency’s control. During public health emergencies, including COVID-19, states may experience workforce shortages or applicants may be unable to receive or respond to requests for information. The timeliness standard exception in Medicaid does not require a state plan amendment (SPA) but states must document the reason for the delay in the individual’s case file. If states seek a timeliness standard exception broadly, they should seek CMS’ concurrence that the flexibility is needed. CHIP agencies must submit a disaster relief state plan amendment to utilize this exception, or notify CMS if such a plan is already in place.
• If states take advantage of flexibility in meeting timeliness standards for renewals, they must continue to provide coverage until a person is determined ineligible. Similar to the flexibility regarding application timeliness standards, a state plan amendment is not needed for Medicaid agencies to use this flexibility but CMS concurrence is needed if adopted on a broader than case-by-case basis.
• States may extend renewal periods for non-MAGI groups. While the ACA requires a 12-month renewal period for MAGI groups, it does not apply to coverage for seniors or individuals with disabilities. States have the option to extend renewals for these groups but cannot do so for a narrow group affected by a particular diagnosis, such COVID-19. A state plan amendment is needed to extend the renewal period for non-MAGI groups.
• States may stop charging copayments during a public health emergency but exemptions from copayments cannot be applied narrowly based on diagnosis. To take advantage of this flexibility, Medicaid agencies must file a state plan amendment and CHIP agencies must utilize a disaster relief SPA.

In addition to the eligibility and enrollment flexibilities, the latest guidance from CMS highlights the agency’s disaster response toolkit. The toolkit is organized by operational areas, including benefits, cost-sharing, and provider workforce, and outlines numerous strategies available to support Medicaid and CHIP agencies and enrollees. The toolkit also describes authority that may be granted under Section 1135 waivers should the President declare an emergency or natural disaster. You may also find this Commonwealth Fund blog by our George Washington colleague Sara Rosenbaum helpful.

Meanwhile, Congress is working on several stimulus proposals that could provide additional resources to states during this pandemic, including potentially boosting the federal Medicaid assistance percentage (FMAP) that states receive. Increases in the federal match rate have been critical to states during past economic downturns in the past. And while our attention must be focused on dealing with the crisis at hand, I’d be remiss if I failed to point out that it is precisely these kinds of events that remind us of the danger posed by this administration’s efforts to undermine Medicaid. Attempts to repeal the ACA, tighten up eligibility requirements, restrict how states can raise their share of Medicaid funding and promote block grants and other capped funding strategies ultimately would limit state capacity to respond effectively to public health emergencies.