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CMS Releases Final Rule on Medicaid Eligibility

Monday, July 08, 2013

On July 5, 2013, the Centers for Medicare and Medicaid Services (CMS) released a final rule addressing new eligibility guidance for Medicaid, the Children's Health Insurance Program (CHIP), and the Exchanges. The new rule, titled "Medicaid and Children's Health Insurance Programs: Essential Health Benefits in Alternative Benefit Plans, Eligibility Notices, Fair Hearing and Appeal Processes, and Premiums and Cost Sharing; Exchanges: Eligibility and Enrollment," also includes regulations for benefits and cost sharing for Medicaid programs, codifies eligibility and enrollment rules included in the Affordable Care Act (ACA) and provides guidance to states for establishing Health Insurance Market Places.

The new rule does not include all of the proposed changes presented in the notice of proposed rule-making (NPRM) issued on January 22, 2013. Regulations in this new rule focus on the elements most critical to implementing the ACA in January 2014. 

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