Medicaid and CHIP Loss of Coverage SEP
New Special Enrollment Period (SEP) available for Medicaid or CHIP recipients soon to lose coverage.
Continuous Enrollment Ending
HHS announced a new Marketplace special enrollment period (SEP) that will be available in states that use HealthCare.gov and optional for states with State-Based Marketplaces.
♦ People who lose Medicaid or Children’s Health Insurance Program (CHIP) coverage any time between March 31, 2023 and July 31, 2024 will be eligible for a Marketplace SEP.
After a person is determined eligible for the Marketplace, they will have 60 days to choose a plan, and their coverage will start the first day of the month after they choose a plan.
Here are the highlights
On December 29th, Congress passed an end-of-the year spending billed called the Consolidated Appropriations Act (2023).
The act provides funding for many things but it also has an amendment in it that affects Medicaid and CHIP recipients by ending ‘continuous enrollment’ provisions put in place during the Covid-19 emergency.
• At the start of the pandemic, Congress enacted the Families First Coronavirus Response Act (FFCRA), which included a requirement that Medicaid programs keep people continuously enrolled through the end of the month in which the COVID-19 public health emergency (PHE) ends.
In exchange for doing this, states were able to receive enhanced federal funding.
Primarily due to the continuous enrollment provision, Medicaid enrollment has grown substantially compared to before the pandemic and the uninsured rate as dropped.
♦ When the continuous enrollment provision ends, millions of people could lose coverage which would reverse recent gains in coverage.
Congress set an end date for the continuous enrollment provision as March 31, 2023.
The Department of Health and Human Services (HHS) estimates as many as 15 million people will be disenrolled, including 6.8 million who likely still will be eligible.
The share of individuals disenrolled across states will vary due to differences in how states prioritize renewals.
• It is expected that the groups that experienced the most growth due to the continuous enrollment provision—ACA expansion adults, other adults, and children—will experience the largest enrollment declines.
To give states time to prepare, Congress set a ‘phase down’ or ‘unwinding’ to the enhanced federal Medicaid matching funds. The unwinding runs through December 2023.
How long the unwinding takes depends upon the states.
♦ States that accepted the enhanced federal funding can resume disenrolling people beginning on April 1st.
• Beneficiaries whose coverage is terminated on April 1 could have their last date of Medicaid coverage be March 31, 2023.
States cannot restrict eligibility standards, methodologies, and procedures and states cannot increase premiums as required in FFCRA.
In addition, states must also comply with federal rules about conducting renewals.
States are also required to maintain up to date contact information, and attempt to contact enrollees prior to disenrollment.
What should you do if you are not sure whether your Medicaid or CHIP coverage was terminated?
You should contact your Medicaid or CHIP agency as soon as possible to ensure the agency has your up-to-date contact information, and to ensure you are receiving all communications regarding the status of your enrollment.
It is expected that people will face challenges transitioning from Medicaid or CHIP to the Marketplace.
♦ One of the biggest challenges is that they may not learn that they have lost coverage in time to act before the end of the current loss of coverage SEP.
That is one reason for this new exceptional circumstances SEP. It will ensure that anyone who loses Medicaid or CHIP during the unwinding period can enroll in Marketplace coverage when they are able.
• Individuals and families in Marketplaces served by HealthCare.gov can enroll in Marketplace health insurance coverage outside of the annual open enrollment period.
This new SEP is triggered when someone answers “yes” to the application questions asking if their Medicaid or CHIP coverage ended recently or will end soon.
• You will not be required to supply documentation to verify the loss of Medicaid or CHIP coverage.
Marketplace coverage will start the first day of the month following plan selection. For example, if someone who is eligible for this SEP selects a plan on August 20, 2023, Marketplace coverage will start on September 1, 2023.
♦ You do not have to wait for their Medicaid or CHIP coverage to end, before submitting an application for Marketplace coverage.
Anyone losing minimum essential coverage (MEC), such as Medicaid or CHIP, may report that loss of coverage up to 60 days before their last day of Medicaid or CHIP coverage.
• Anyone who submits a new application or updates an existing application between March 31, 2023 and July 31, 2024 is eligible for this new SEP.
Note: After July 31, 2024, anyone who was unable to enroll in Marketplace coverage because they did not receive a timely notice of termination of Medicaid or CHIP coverage, may still be eligible for this SEP.
You will need to contact the Marketplace Call Center at 1-800-318-2596 (TTY: 1-855-889-4325) to request an SEP, which will be granted on a case-by-case basis.