This overview is excerpted from Manatt on Health, Manatt’s subscription service that provides in-depth insights and analysis focused on the legal, policy and market developments.
On August 19, the Centers for Medicare & Medicaid Services (CMS) released a Center for Medicaid and CHIP Services (CMCS) Informational Bulletin (CIB) and an accompanying slide deck reminding states of their obligation to comply with federal Medicaid renewal requirements1 and identifying optional state strategies to ensure continuity of coverage among individuals receiving Medicaid home- and community-based services (HCBS).
To facilitate ongoing receipt of services in the home and the community, CMS encourages states to adopt flexibilities, such as disregarding income and assets for HCBS recipients, adopting certain Section 1902(e)(14) waivers, partnering with local agencies to enhance “No Wrong Door” systems, and performing level of care evaluations and person-centered service plan reviews prior to the financial eligibility renewal.
For HCBS recipients who are disenrolled from Medicaid for procedural reasons (e.g., failure to return the renewal form) and likely to reenroll, CMS encourages states to reserve a portion of HCBS waiver slots, prioritize entry into the HCBS program, allow for provisional person-centered service plans—which identify the essential Medicaid services that will be provided for 60 days, and rely on a level of care re-evaluation (for section 1915(c) and 1915(k)) or assessment of needs-based criteria (for section 1915(i)) completed within the past 12 months to determine eligibility.
1 These renewal requirements are found in 42 C.F.R. § 435.916 and in CMS’ Streamlining the Medicaid, Children’s Health Insurance Program, and Basic Health Program Application, Eligibility Determination, Enrollment, and Renewal Processes final rule.
