Basic Requirements for Conducting Ex Parte Renewals of Medicaid and CHIP Eligibility
Centers for Medicare & Medicaid Services (CMS) guidance outlines mandatory ex parte (automatic eligibility) renewal procedures, requiring states to use all available data sources, including those previously deemed incomplete or unreliable, before contacting beneficiaries.
While the guidance reinforces existing statutory requirements for states to attempt ex parte renewals and ensure procedural safeguards, it introduces new and restrictive mandates that limit state flexibility. States are now required to use all available data sources, regardless of reliability, before requesting verification documents or other supplementary information. Additionally, the guidance prohibits states from excluding specific populations, such as childless adults, from the ex parte renewal process, even when verifying their eligibility electronically presents challenges. Previously, states had the discretion to determine the reliability of data sources and exclude certain populations, allowing them to tailor processes to maintain program integrity.
Medicaid law requires states to ensure that individuals remain eligible for Medicaid coverage while complying with basic procedural safeguards, including advance notice and an opportunity for a fair hearing before adverse actions. The statute does not prescribe the specific methods or data sources states must use to verify eligibility or mandate inclusion of all populations in ex parte renewals. By imposing these new obligations without statutory backing, CMS appears to exceed its authority and undermine state flexibility in implementing Medicaid program requirements.
