CMS publishes Medicaid and CHIP appeals and eligibility rules

The Centers for Medicare & Medicaid Services yesterday released two rules, one final and one proposed, to address eligibility and appeals processes for the Medicaid and CHIP programs. The final rule completes the agency’s work related to appeals, notices and Medicaid eligibility changes under the Affordable Care Act. Among the many provisions, the rule would provide pregnant women with continuous eligibility for pregnancy related services until the end of the month of the post-partum period. It also would provide continuous eligibility for hospitalized children through the end of the inpatient stay if he/she would otherwise lose eligibility due to age. The final rule takes effect Jan. 20. The proposed rule includes provisions to align the eligibility appeals processes between the Health Insurance Marketplaces and Medicaid, such as allowing Medicaid beneficiaries the same fair hearing appeals time frame allowed individuals through the Marketplaces. Comments are due on the proposed rule by Jan. 30.