CMS Opens Special Enrollment Period with ACA for Those Losing Medicaid

Centers for Medicare and Medicaid Services is opening a special Affordable Care Act enrollment period for beneficiaries who lose their Medicaid or children’s health insurance coverage due to the end of the continuing enrollment requirement.

On Friday, CMS released information about a temporary special registration period under exceptional circumstances from March 31 to July 31.

Marketplaces using the federal platform will give eligible consumers additional flexibility to enroll in coverage during and immediately after the end of the Medicaid Continuous Enrollment Waiver Period, CMS said. It starts on April 1st when the states start redefining.

WHY IS IT IMPORTANT

Up to 18 million people are projected to lose Medicaid coverage as the continuing enrollment requirement due to the public health emergency ends.

The Families First Coronavirus Response Act does not allow state Medicaid agencies to exclude people from enrollment during PHE.

The cumulative spending package passed at the end of 2022 gave states information about Medicaid coverage. Under the bill, states will be able to start processing Medicaid re-determinations starting April 1, whether PHE is in effect or not.

This has previously left the question of whether exiting Medicaid qualifies as a “qualifying event” for health insurance enrollment under the ACA without waiting for open enrollment to begin in November.

Friday’s CMS guidance aims to close any gaps in coverage for a smooth transition from one type of health insurance to another.

In the letter, CMS said it is providing additional flexibility to states and marketplaces during the roll-out period to help beneficiaries maintain continuity of coverage when moving from Medicaid or CHIP to a market-responsive health plan.

The current public health emergency ends April 11. If PHE is not continued as expected, service providers will receive their promised 60-day notice on February 10th.

BIG TREND

On December 19, 2022, 25 governors sent a letter to President Biden asking him to end the public health emergency in April as the continuation of PHE would negatively impact states financially as they would have to increase their non-federal matching funds to cover the population with Medicaid. .

On Friday, CMS released a State Public Health Letter outlining the new requirements of the Consolidated Appropriations Act for 2023 that affect the state’s Medicaid and CHIP performance regarding the Medicaid continuity enrollment condition.

The SHO letter also addresses changes to other conditions that states must meet to receive an increased percentage of federal care, as well as reporting requirements and new enforcement powers for CMS to ensure state compliance.

Twitter: @SusanJMorse
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