What’s Ahead for Rulemaking: Medicaid Edition

The Centers for Medicare and Medicaid Services (CMS) is preparing for the unwinding of the COVID-19 public health emergency (PHE) when states will resume Medicaid eligibility redeterminations. The PHE is currently set to expire on April 16. However, we anticipate HHS Secretary Xavier Becerra will renew the PHE another 90 days through July 16, since the Biden Administration did not notify states on February 15 (i.e., 60-day mark) that the PHE would not be renewed.

Below, we outline key activities and dates the Administration will take with respect to Medicaid. An outlook for key upcoming Medicare-related activities is available here.

  • March 28 – Grant Application Deadline: Applications for the $49.4 million funding opportunity to boost enrollment of eligible children, parents, and pregnant people in Medicaid and CHIP are due March 28. Activities will include outreach and application and renewal assistance. CMS anticipates issuing 36 cooperative agreement awards, up to $1.5 million each for a three-year period.
    • July 1 – Anticipated Award Date: The anticipated award date is July 1, 2022, which would provide recipients (such as state and local governments and nonprofits) with additional resources to support mass eligibility redeterminations, possibly beginning in mid-July. The performance period is July 1, 2022 to June 25, 2025.
  • Late March – Special Enrollment Period: A Special Enrollment Period (SEP) intended to transition Medicaid enrollees to Exchange plans will be available through healthcare.gov in late March. Individuals with an income no greater than 150 percent of the federal poverty level (FPL) and who are eligible for advance payment of premium tax credits (APTCs) will be eligible. This SEP is only available during the period of time when APTC benefits are available so that the applicable taxpayer has an applicable percentage of zero (i.e., 2021 and 2022). This policy was finalized in the third installment of the Notice of Benefit and Payment Parameters for 2022.
  • April 18 – RFI Comment Deadline: Comments for the recently announced RFI on access to care and coverage for Medicaid and CHIP enrollees are due April 18. CMS intends to use comments to inform the development of their comprehensive strategy to ensure more equitable access for all Medicaid and CHIP populations and inform future policy, monitoring, and regulatory actions.
  • Late April – Anticipated Rulemaking: According to the Fall 2021 Unified Agenda, CMS plans to issue a proposed rule intended to minimize coverage loss due to mass eligibility redeterminations trigged by the PHE expiration. The proposed rule would streamline the application, eligibility determination, enrollment, and renewal processes for Medicaid and CHIP. Since the RFI will inform this rulemaking, CMS will likely release the proposed rule after the April 18 comment deadline, possibly late April. If CMS follows typical time periods for comment periods and effective dates, the effective date of the proposed rule could be after July 16, the possible expiration of the PHE.
    • Late June – Possible Comment Deadline: In general, the comment period for proposed rules is 60 days. Therefore, the comment deadline for the CMS proposed rule on Medicaid and CHIP enrollment could be in late June.
    • Late August – Possible Effective Date: The effective date for “economically significant” final rules is typically 60 days after publication in the Federal Register. Therefore, the effective date for the CMS proposed rule could be in late August.

Alyssa Llamas has a diverse background in health policy and public health, with seven years of experience in government, research