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HHS/CMS RIN: 0938-AU00 Publication ID: Fall 2023 
Title: Streamlining the Medicaid, CHIP, and BHP Application, Eligibility Determination, Enrollment, and Renewal Processes (CMS-2421) 

This rule implements changes to simplify the processes for eligible individuals to enroll and retain eligibility in Medicaid, the Children's Health Insurance Program (CHIP), and the Basic Health Program (BHP).  The changes will be finalized in two rules.  The first final rule removes barriers and facilitates enrollment of new applicants, particularly those dually eligible for Medicare and Medicaid.  The second final rule will follow in CY 2024 and implement changes to align enrollment and renewal requirements for most individuals in Medicaid; establish beneficiary protections related to returned mail; create timeliness requirements for redeterminations of eligibility in Medicaid and CHIP; make transitions between programs easier; eliminate access barriers for children enrolled in CHIP by prohibiting premium lock-out periods, waiting periods, and benefit limitations; and modernize recordkeeping requirements to ensure proper documentation of eligibility and enrollment.

Agency: Department of Health and Human Services(HHS)  Priority: Section 3(f)(1) Significant 
RIN Status: Previously published in the Unified Agenda Agenda Stage of Rulemaking: Final Rule Stage 
Major: Yes  Unfunded Mandates: No 
CFR Citation: 42 CFR 431    42 CFR 435    42 CFR 457    42 CFR 600    ...     (To search for a specific CFR, visit the Code of Federal Regulations.)
Legal Authority: 42 U.S.C. 1302   
Legal Deadline:  None

Statement of Need:

Since the implementation of the Affordable Care Act (ACA), CMS has made improvements in streamlining the Medicaid and CHIP application, eligibility determination, enrollment, and renewal processes. Simplifying enrollment in Medicaid and CHIP coverage is a foundational step in efforts to address health disparities for low-income individuals.  However, gaps remain in States’ ability to seamlessly process beneficiaries’ eligibility and enrollment in order to maximize coverage. This rule will provide States with the tools they need to reduce unnecessary barriers to enrollment in Medicaid and CHIP and to keep eligible beneficiaries covered.  CMS engaged in a series of discussions with state Medicaid and CHIP agencies during development of the proposed rule, to examine enrollment barriers and discuss potential options for relief.

Summary of the Legal Basis:

This rule responds to the January 28, 2021, Executive Order on Strengthening Medicaid and the Affordable Care Act.  It addresses components of title XIX and title XXI of the Social Security Act and several sections of the Patient Protection and Affordable Care Act (Pub. L. 111-148) and the Health Care and Education Reconciliation Act of 2010 (Pub. L. 111-152), which amended and revised several provisions of the Patient Protection and Affordable Care Act.


In developing the policies contained in this rule, we considered numerous alternatives, including maintaining existing requirements.  These alternatives are described in the rule.

Anticipated Costs and Benefits:

The provisions in this rule will streamline Medicaid and CHIP enrollment processes and ensure that eligible beneficiaries can maintain coverage.  While states and the Federal Government will incur initial costs to implement these changes, this rule aims to reduce administrative barriers to enrollment, which is expected to reduce administrative costs over time.  The provisions in this rule are designed to increase access to affordable health coverage, and we believe that the benefits will justify the costs.  Additionally, through clear and consistent requirements for the timely renewal of eligibility for all beneficiaries, this rule promotes program integrity, thereby protecting taxpayer funds at both the state and federal levels.  As we move toward publication, estimates of the cost and benefits of these provisions will be included in the rule.


We anticipate that the provisions of this rule will further the administration’s goal of strengthening Medicaid and making high-quality health care accessible and affordable for every American.  At the same time, through clear and consistent requirements for conducting regular renewals of eligibility, acting on changes reported by beneficiaries and maintaining thorough recordkeeping on these activities, this rule will reduce the risk of improper payments.

Action Date FR Cite
NPRM  09/07/2022  87 FR 54760   
NPRM Comment Period End  11/07/2022 
1st Final Action  09/21/2023  88 FR 65230   
1st Final Action Effective  11/17/2023 
2nd Final Action  02/00/2024 
Regulatory Flexibility Analysis Required: No  Government Levels Affected: Federal, Local, State 
Federalism: No 
Included in the Regulatory Plan: Yes 
RIN Data Printed in the FR: No 
Agency Contact:
Sarah Delone
Deputy Director, Children and Adults Health Programs Group
Department of Health and Human Services
Centers for Medicare & Medicaid Services
S2-01-16, Center for Medicaid and CHIP Services, MS: S2-01-16, 7500 Security Boulevard,
Baltimore, MD 21244
Phone:410 786-5647