CMS will not approve any new waivers for states to allow continuous enrollment for Medicaid or CHIP beneficiaries longer than 12 months.
- CMS policy change: CMS announced it will no longer approve new or extend existing Section 1115 demonstrations that expand continuous Medicaid or CHIP eligibility beyond current statutory limits.
- Reason for change: Concerns about fiscal and program integrity drive this shift, as expanded continuous eligibility can result in prolonged enrollment of individuals who may no longer meet eligibility criteria.
- Existing programs affected: States currently using Section 1115 authority for expanded continuous eligibility must prepare to phase out this authority, with CMS providing technical assistance and requiring states to notify affected beneficiaries and provide fair hearing and review. For individuals determined ineligible for Medicaid or CHIP, the state must determine potential eligibility for other insurance affordability programs and comply with federal regulations.
- Background context: Federal law mandates 12 months of continuous eligibility for children under 19 starting January 1, 2024. Some states had used Section 1115 to extend coverage beyond that, including for adults, which CMS now views as problematic.
- Focus on vulnerable populations: CMS emphasizes that Medicaid and CHIP are safety net programs meant for the most vulnerable and intends to safeguard resources accordingly.
