In November 2018, the Centers for Medicare and Medicaid Services (CMS) released new Medicaid and Children's Health Insurance Program (CHIP) application processing time data, which show how quickly states are completing eligibility determinations. The Affordable Care Act (ACA) established streamlined Medicaid and CHIP enrollment and renewal processes that utilize electronic data matches to verify eligibility, facilitating individuals' ability to access and maintain coverage and providing opportunities for administrative improvements in states. This brief analyzes the CMS application processing time data and uses the 2018 Kaiser Family Foundation survey of state Medicaid and CHIP eligibility and enrollment policies to examine selected eligibility and enrollment policies by application processing time. It finds: (1) Across the 42 states reporting data for February to April 2018, on average, over half (53%) of applications were processed within 7 days, including over a third (34%) processed in real-time (less than 24 hours) (Figure 1). (2) States varied in how quickly they processed applications. On average, states that adopted the ACA Medicaid expansion processed applications faster than non-expansion states. (3) States with faster application processing generally had broader eligibility compared to slower states. They also were more likely to receive most of their applications online and to allow individuals to upload documentation electronically, which may facilitate faster application processing. Further, likely reflecting effective electronic data matching capabilities, states with faster application processing also were more likely to process the majority of renewals automatically. States' ability to make real-time eligibility determinations illustrates the significant progress achieved in streamlining and modernizing enrollment under the ACA. However, there remains significant variation across states and opportunities for continued improvement. Recent waivers in some states to add eligibility and enrollment restrictions, including work reporting requirements, could reverse the progress achieved in streamlining enrollment, resulting in additional barriers to coverage and coverage losses.
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