Congressional leaders have repeatedly said they are going to protect the most vulnerable from a loss of Medicaid coverage and focus on addressing “waste, fraud, and abuse” but rescinding the Eligibility and Enrollment rule would do neither.
The Eligibility and Enrollment Rule (E&E rule) finalized by the Biden Administration in April 2024 is on the chopping block. Repealing, rescinding or choosing not to enforce this rule is not only short-sighted, but it is counter to everything policymakers are saying about making Medicaid more efficient and addressing waste, fraud, and abuse. Let’s look at the facts.
Congressional leaders say they want to protect coverage for children but…children in CHIP lose out if the E&E rule is rescinded. The rule would ensure that kids whose family income goes over the Medicaid threshold are transitioned to the Children’s Health Insurance Program (CHIP) without additional paperwork or a gap in coverage. The rule puts CHIP on par with private and Marketplace insurance by not allowing annual or lifetime dollar limits on services. Think about the child with cancer or ongoing special health care needs. The rule also protects CHIP kids from gaps in coverage by disallowing uninsured waiting periods prior to enrollment and coverage lockouts if families miss a single premium payment.
Congressional leaders say they want to make sure Medicaid works for the most vulnerable but…people with disabilities and seniors will lose out if the E&E rule is rescinded. The rule aims to reduce complexity in eligibility determinations and enrollment processes, especially for individuals with disabilities and older adults (non-MAGI groups). It expands the modes (online, phone, mail, in-person) used to accept applications and renewals for non-MAGI enrollees. The rule ensures that all enrollees have at least 30 days to submit documents needed to verify eligibility at renewal or when a change in circumstance occurs. The current 10-day minimum notice requirements are woefully inadequate given mail delays and amount of time needed to submit and process information. Once an application is closed or a person is disenrolled for missing the deadline to submit documents, eligible individuals may experience gaps in coverage before getting re-enrolled. This churn adds to a state’s administrative burden and health plan costs associated with disenrollment and re-enrollment.
Congressional leaders say they want to crack down on Medicaid fraud, waste, and abuse but…repealing the rule means rolling back positive steps to improve program integrity. For the record, there is negligible evidence of beneficiary fraud. If you want to rout out fraud, you must follow the money. While almost all (95%) of Medicaid payments were accurate, critics like to point to the 5% improper payment rate as a proxy for fraud. It’s not. Four out of five “improper payments” are due to a lack of adequate documentation, and no wonder. The rules on documentation haven’t been updated since 1986 – long before the digital age and today’s technology!!! Rescinding the rule would leave decades old rules in place, hindering an accurate accounting of true improper payments.
Congressional leaders say they want Medicaid to be more efficient but … repealing the rule means redundant paperwork to verify citizenship status. State vital statistics records and the Department of Homeland Security are the most accurate sources of birthplace and citizenship or lawful status. The rule accepts these sources of verification without requiring duplicative documentation. Eliminating the rule continues the unnecessary burden of submitting and processing a second document to prove identity.
Congressional leaders say they want Medicaid to be more cost-effective but … rescinding the rule for tackling the costly problem of returned mail is not cost-effective or efficient. Maintaining up-to-date address and contact information for Medicaid members has been a longstanding challenge for states and many fell further behind during the COVID-related three-year pause on Medicaid disenrollments. The E&E rule establishes efficient and proactive processes for keeping contact information up-to-date and accepting new contact information from trusted sources like the USPS National Change of Address Database and contracted managed care plans.
Congressional leaders say they want to reform Medicaid but … repealing the E&E rule rolls back reform by eliminating new policies intended to harness technology and improve program integrity. Manual processes and redundant paperwork are costly and prone to human error.The E&E rule takes advantage of technology and data-driven processes to modernize eligibility and enrollment. Provisions, throughout the rule, aim to leverage technology and electronic data to more efficiently and accurately administer Medicaid.
If Congressional leaders truly want to prioritize children, seniors, and people with disabilities, repealing the E&E rule should be off the table.