Medicaid Eligibility and Enrollment Rule Advances Program Integrity and Coverage

The Biden Administration's Eligibility and Enrollment (E&E) rule for Medicaid, finalized in April 2024, is facing potential repeal despite its intended benefits for vulnerable populations. Contrary to claims that repealing the rule protects Medicaid's most vulnerable, rescinding it would disrupt coverage continuity for children transitioning from Medicaid to the Children's Health Insurance Program (CHIP), particularly by eliminating protections from coverage gaps and service limits. For seniors and people with disabilities, the rule simplifies eligibility and enrollment processes and extends timeframes for document submission, reducing disenrollment churn that increases administrative costs and coverage gaps.

Opponents of the E&E rule cite waste, fraud, and abuse concerns; however, evidence suggests beneficiary fraud is minimal, with most improper payments linked to outdated documentation requirements dating back to 1986. Rescinding the rule would abandon modernized documentation standards that leverage technology to improve program integrity. The rule also streamlines verification processes by accepting state vital records and Department of Homeland Security data, cutting redundant paperwork related to citizenship verification.

Efforts to keep Medicaid data accurate, such as provisions addressing returned mail through trusted sources like the USPS National Change of Address Database and managed care plans, are embedded in the E&E rule. Eliminating these measures risks exacerbating administrative inefficiencies and coverage disruption. By harnessing technology and data-driven solutions, the rule modernizes Medicaid administration, enhancing cost-effectiveness and accuracy.

The debate over the E&E rule highlights tensions between stated goals to protect vulnerable populations and improve Medicaid efficiency versus the operational impacts of repealing modernization efforts. Maintaining the rule supports seamless coverage transitions, reduces administrative burden, curtails fraudulent claims through better documentation, and utilizes proactive data management techniques. As policymakers evaluate Medicaid reform, preserving the E&E rule aligns with broader objectives to improve program integrity and beneficiary outcomes without adding redundant barriers.