Navigating the evolution of benefits streamlining: Considerations for U.S. states following the new CMS rule for Medicaid

This month, the Biden-Harris Administration released a final rule centered around streamlining eligibility and entitlement to key benefits, with a focus on Medicaid, the Children's Health Insurance Program (CHIP), and the Basic Health Program (BHP). A guiding purpose of this new rule is to ensure that the most vulnerable populations, including children, older individuals, and people with disabilities, continue getting the critical services they need from these programs.

Last year the U.S. government declared the end of the COVID-19 public health emergency, leading health and human services (HHS) agencies across the country to evaluate their Medicaid rolls, redetermine eligibility, and streamline their renewals process. This initiative, known as the Medicaid Unwinding, offered a unique opportunity to evaluate technology investments that can address core challenges across programs. The lessons learned from Medicaid Unwinding paved the way for states to take on new initiatives, including this new streamlining rule.

The new Medicaid streamlining rule

The new rule incorporates provisions to simplify Medicaid enrollment and renewal processes and will require states to make policy changes, improve processes, and update their Medicaid eligibility systems. It includes multiple timelines to meet its requirements, including completing changes to the Traditional Medicaid (Non-MAGI) program by June 2027. States running their Traditional Medicaid programs on legacy systems will likely require modernization investments in those systems. For new technology investments, The Centers for Medicare and Medicaid Services (CMS) is providing 90/10 funding to aid states in their modernization efforts.

To make the process of applying and renewing Medicaid coverage easier, states will be required to simplify the citizen experience by removing unnecessary barriers to enrollment, addressing unnecessary administrative hurdles, and simplifying eligibility requirements.

It is imperative that states create plans to improve processes and modernize technology in a way that addresses the current requirements and also future proofs their systems to accommodate an ever-changing health and human services (HHS) landscape.

Building on the Affordable Care Act and Unwinding

The new rule is continuing the work of the Affordable Care Act (ACA) and Unwinding with the common goal of making it easier to obtain and retain coverage. These prior initiatives showed that simplifying and streamlining key processes with technology, process improvement, and policy changes improved Medicaid access and coverage of eligible individuals and increased citizen engagement; all key objectives of the new rule.

States should use this experience to inform their modernization initiatives – extending their own successes or learning from colleagues – to streamline the citizen and caseworker experience with capabilities like self-service and program-specific automation.

What might that look like in practice? With the right technology, this can mean comprehensive self-service to support application, renewals, change of circumstances, and more – all at the hands of the individuals. Two of Cúram’s partners, New York City and Washington D.C., are prime examples of how to implement a human-centered approach when developing online portals. These approaches support multiple HHS programs (e.g. SNAP, TANF, Medicaid) and utilize extended functionality like document uploads and renewals processing to provide a positive user experience.

For caseworkers, program-specific automation can help reduce their workload. The user experience for both caseworkers and citizens can be improved with the use of electronic data sources and existing system data to automate the verification process. This simplifies the application and renewals processes by collecting only the information needed to close a gap in evidence to support eligibility. With the right tools, the investment in streamlining all Medicaid programs can be part of the journey that makes benefits more accessible to the individuals who need them most.

Future proofing with the right platform and partner

The concepts introduced with the ACA, emphasized with Unwinding, and continuing with this new rule are not going away. Similar initiatives will span HHS programs and continue to be introduced to ensure that it is easier for individuals to obtain and maintain eligibility across any program. While the rule’s primary focus is Medicaid, states will benefit from investing in technology that is proven and can extend to support more programs in the future.

States will need a flexible eligibility system that can integrate different programs, meet existing and emerging program and funding requirements, and deliver on their own efficiency and effectiveness needs. This will require a platform that is proven, compliant, and has the functionality and capabilities to support the HHS enterprise.

There are a lot of options when it comes to technology, but the best way for states to future proof their streamlining initiatives is to find a partner who is already successful in supporting the core eligibility and entitlement programs in Medicaid, SNAP, TANF, etc. Technology that is purpose-built for HHS and backed by a partner with deep subject matter expertise makes both standing up new programs, as well as integrating across programs, more efficient and cost effective.

A technology platform that enables the reuse of existing solutions, and potentially in partnership with other states, will be of keen interest to both the states and CMS. This is why the right technology partner is so integral to a project’s success. With an integrated eligibility and entitlement platform, states will be better positioned to streamline processes across multiple programs and support a “no wrong door” objective for their citizens with automated, backend processes that keep everything streamlined and in sync.

Learn more about Cúram, and how our technology supports HHS agencies on their modernization journey.

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