Over the weekend, CCF posted a brief explaining the Medicaid and CHIP provisions in the Families First Coronavirus Response Act enacted on March 18, 2020. In particular, we highlighted four requirements that states must meet in order to qualify for the 6.2 percentage point FMAP bump. Like the current maintenance of effort (MOE) protecting Medicaid and CHIP coverage for children, states may not add new restrictive eligibility or enrollment requirements or increase premiums above levels in place as of January 1, 2020 during the public health emergency. Testing and treatment from COVID-19 must also be covered without cost-sharing. But as someone who has been tracking the declining enrollment in Medicaid and CHIP, my favorite MOE provision is a “freeze” on disenrollment in Medicaid.

What does a freeze on Medicaid disenrollment mean?

States may not disenroll any beneficiary who was enrolled in Medicaid as of March 18, 2020, or anyone who newly enrolls until after the national emergency declaration has been lifted. In essence, it provides continuous eligibility to ALL current beneficiaries and new enrollees in Medicaid unless they move out-of-state or request voluntary termination.

States should suspend renewals and periodic reviews of eligibility.

While the new law freezes disenrollment, it doesn’t explicitly require states to stop processing renewals or conducting periodic “behind the scenes” reviews of eligibility using data matches with electronic sources used to verify eligibility such as quarterly wage data. But it simply makes no sense for states to dedicate staff resources to these tasks when there will an increasing number of new applications for individuals whose circumstances are changing in addition to uninsured individuals who will be newly eligible for testing in states that pick up the new optional group.

States must immediately reprogram their eligibility systems to stop auto-closures.

Some states have designed their eligibility systems to automatically terminate coverage under specific circumstances. For example, Texas conducts periodic income checks for children in the fifth, sixth, seventh and eighth month of enrollment. If information is not provided and entered into the system, it is programmed to automatically close these cases.

States must immediately reinstate Medicaid beneficiaries who have been disenrolled on or after March 18, 2020.

The disenrollment freeze went into effect on March 18, 2020; however, eligibility worker training and system changes are necessary to implement the freeze. Clearly, some beneficiaries will have slipped through the cracks already. States should put procedures in place to reinstate any cases that have been or are being closed until systems have been updated.

Coverage for pregnant women must be extended beyond 60 days post-partum.

The disenrollment freeze applies to all Medicaid beneficiaries, including pregnant women. This means that pregnant women should continue receiving Medicaid beyond 60 days postpartum. However, because the Families First MOE doesn’t apply to CHIP, pregnant women covered by CHIP in six states (CO, MO, NJ, RI, VA, WV) will not be protected.

Congress should extend the disenrollment freeze to CHIP or states should seek suspension of CHIP renewals.

Unfortunately, neither the Families First MOE nor the disenrollment freeze apply to children and pregnant women covered in CHIP.¹ This lack of coordination between Medicaid and CHIP could make it more difficult for states to reprogram their current eligibility systems to continue processing renewals or using periodic reviews of eligibility to identify changes in circumstances in CHIP. Short of Congress taking action to extend the disenrollment freeze to CHIP, we would urge states to request and CMS to approve the suspension of CHIP renewals during this public health emergency. Seamless coordination between Medicaid and CHIP has been a long-term goal and to disentangle the integration between the programs will waste resources at a time when keeping everyone covered should be a top priority.

1. There is currently an MOE for children in Medicaid and CHIP that is in effect until 2027. It prohibits more restrictive eligibility and enrollment requirements and disallows premium increases above routine increases based on inflation or what was approved in the state’s CHIP plan as of January 2010. Families First does require CHIP to cover COVID-19 testing without cost-sharing but the disenrollment freeze does not apply to CHIP.