Page 36

Page 36 – CMCS Informational Bulletin Eligibility and Enrollment Final Rule Provisions Subject to Moratorium (Do Not Apply During Moratorium) CMS is prohibited from implementing, administering or enforcing the policies described below until the moratorium ends on September 30, 2034. States should refer to the Code of Federal Regulations in effect as of June 2, 2024, for requirements under the below listed rules while the moratorium is in effect. Regulation Description of Provision as Amended by 2024 Eligibility and Enrollment Final Rule 42 CFR §§ 457.1140(d)(4), 457.1170 Specifies that states must also provide beneficiaries with the opportunity to continue CHIP benefits when the state fails to make a timely eligibility determination. Technical edits were also made to regulations at 42 CFR § 457.1140(d)(4) to cross reference changes made to § 457.1170, and this technical change is also subject to the moratorium. 42 CFR § 457.1180 Clarifies that notice of an action that is subject to review must also include an explanation of the circumstances under which benefits may continue pending the review. Eligibility and Enrollment Final Rule Provisions Excluded from Moratorium (Current Rules Apply) CMS is not prohibited from implementing, administering or enforcing the policies described below. States should refer to the current Code of Federal Regulations for requirements, including while the moratorium is in effect. Regulation Description of Provision as Amended by 2024 Eligibility and Enrollment Final Rule 42 CFR § 431.10 Includes separate CHIPs and Basic Health Programs (BHPs) on list of entities to which Medicaid agencies may delegate authority to make eligibility determinations. 42 CFR § 431.17 Specifies the type of information and length of time states must maintain eligibility determination records. 42 CFR § 431.231(d) (removal) Removes 42 CFR § 431.231(d) and relocates requirements regarding reinstatement of coverage when a beneficiary’s whereabouts become known to new 42 CFR § 435.919. 42 CFR § 435.223 Creates an optional eligibility group for all or a reasonable classification of individuals under age 21 whose eligibility is excepted from use of the MAGI-based methodology (e.g., those living with a disability). A technical edit was also made to the regulation at 42 CFR § 435.222 to rename the eligibility group that the provision (42 CFR § 435.222) describes and distinguish it from this newly codified group under 42 CFR § 435.223. 42 CFR § 435.601 Updates income counting methodology to account for new optional eligibility group described at 42 CFR § 435.223. 42 CFR § 435.608 and 436.608 (removal) Removes the requirement for applicants and beneficiaries in states and territories to apply for other cash benefits as a condition of Medicaid eligibility. 42 CFR § 435.831 and 436.831 Provides states and territories the option to determine non-institutionalized applicants meet their required “spenddown” for medically needy coverage by adding up their projected predictable expenses instead of requiring individuals to first incur such expenses. 42 CFR § 435.914 Clarifies recordkeeping requirements for Medicaid. 42 CFR § 435.940 Clarifies to which provisions the “Basis and scope” paragraph applies. 42 CFR § 435.952 Clarifies that verification regulations regarding use of electronic data and reasonable compatibility apply to asset verification as well as income.