Eligibility & Enrollment

The Eligibility & Enrollment team at the National Health Law Program (NHeLP) works to ensure that low-income people can access the health coverage and care they need in two ways: first, by expanding who is eligible for affordable, quality health coverage, and second, by ensuring that paperwork and state Medicaid systems do not prevent eligible people from enrolling and staying covered.

While the Affordable Care Act (ACA) substantially expanded Medicaid eligibility, there are still gaps in who is able to get coverage. Not all states have adopted Medicaid expansion and the ACA did not remove long-standing restrictions on immigrants’ eligibility for Medicaid. Meanwhile, overly complicated application and renewal processes mean that many eligible people lose Medicaid coverage for “procedural” reasons, like failing to return a form even though it had been mailed to the wrong address.

We engage with state-level advocates and the US Department of Health & Human Services through its Centers for Medicare & Medicaid Services (CMS) to improve eligibility pathways, simplify enrollment policies and practices, and streamline renewal processes so that more people are eligible for and enrolled in vital health coverage. NHeLP’s Eligibility & Enrollment team also educates advocates across the country on eligibility and enrollment rules and best practices, and develops materials and publications to support advocates assisting low-income health care enrollees on the ground. We endeavor to apply an equity lens to all of our work, and we are vigilant in our efforts to ensure that Black, Indigenous, and people of color, immigrants, individuals with limited English proficiency, and people with disabilities can enroll in—and retain—coverage in a person-centered, equitable way.  

During the Medicaid unwinding, NHeLP’s Eligibility & Enrollment team provided critical support to state-level advocates as state Medicaid agencies embarked on the largest undertaking of Medicaid renewals in the program’s history. Although the official unwinding has ended, eligibility and enrollment issues persist, and NHeLP’s team will continue to work to address these issues.

Intersection of Federal Policy and Eligibility & Enrollment

Our Eligibility & Enrollment team works to expand who is eligible for Medicaid coverage and make it easier for eligible people to stay enrolled without unnecessary barriers. On a federal level, this includes administrative advocacy to improve eligibility policies, simplify application processes, and streamline renewal practices; coalition work to bring local, state, and identity-based partner groups to the policy table; and educational efforts to keep advocates and policymakers informed about the best practices to promote sustained, comprehensive Medicaid coverage. By advocating for more straightforward and accessible policies and practices, we aim to make sure that everyone who needs Medicaid is able to get and keep coverage, free from discriminatory and inaccessible barriers.

In addition to federal advocacy, NHeLP also works on policy in California. For more information about our California policy work, please visit our California Eligibility & Enrollment page.