Renewals in Medicaid and CHIP: Implementation of Streamlined ACA Policies and the Potential Role of Managed Care Plans

In addition to expanding the Medicaid program to cover low-income adults, the Affordable Care Act (ACA) established new modernized, streamlined enrollment and renewal rules for Medicaid and CHIP that are designed to create a coordinated, “no wrong door” system and keep individuals enrolled for as long as they are eligible. States must implement these new policies regardless of whether they adopt the Medicaid expansion to low-income adults.

While much attention has been focused on enrollment efforts, this brief reviews the new renewal requirements for Medicaid and CHIP that are designed to maintain continuity of coverage for eligible individuals. It provides an overview of state implementation of the new renewal policies and considers the potential role managed care plans can play in supporting renewals. Key findings include:

• While states have made significant progress implementing new enrollment processes, some aspects of the simplified renewal policies have not yet been fully implemented due to a range of challenges.
• While many states have been delayed in implementing the streamlined renewal policies, some states, including Washington and Rhode Island, have successfully implemented the new policies and achieved high retention rates with more than nine in ten enrollees successfully renewed.
• Managed care plans can support renewals by reminding members to renew and providing direct assistance with the renewal process. However, plans identified challenges to supporting renewal, including lack of accurate data on member renewal dates; concerns about how marketing guidelines apply to renewal outreach; and lack of clear guidance, expectations, and financial support from states for plans’ role in supporting renewals.