Medicaid Unwinding Updates


From the ACE TA Center Listserv - April 2024

CMS extends “Unwinding SEP” through November 30, 2024

The Centers for Medicare and Medicaid Services (CMS) announced late last month that they will be extending a temporary SEP to help people who are no longer eligible for Medicaid or the Children's Health Insurance Program (CHIP) transition to Marketplace coverage. This extended SEP is only available in states using, however states with state-based Marketplaces may adopt similar extensions.
The end date of this “Unwinding SEP” is now extended to November 30, 2024, which will help more people who are disenrolled from Medicaid or CHIP secure affordable, comprehensive coverage until the next Open Enrollment period starts on November 1st.

For more information about the “Unwinding SEP,” check out the following resources:

Medicaid continuous coverage unwinding update

And don’t forget - the Medicaid unwinding process is still taking place. There are steps you and your programs can take to help people stay covered.
As a reminder, RWHAPs should continue to remind RWHAP clients enrolled in Medicaid and CHIP to carefully review all correspondence related to unwinding and renewals, and encourage them to contact you or your office if they have any questions about how to respond.

In addition to the “Unwinding SEP” described above, there are a number of other SEPs clients can access to enroll into new health coverage if they are no longer eligible for Medicaid.

For clients transitioning to the Marketplace

  • Low-Income SEP: Available to individuals who are eligible for Advance Premium Tax Credits (APTCs) and have an annual project income at or below 150% of the federal poverty level. A person can qualify for this SEP during any month of the year, without experiencing a qualifying life event
  • Loss of Coverage SEP: Allows individuals to access a SEP after losing health coverage, including Medicaid coverage.

Transitioning to Medicare

  • SEP for Loss of Medicaid: Allows individuals to choose between retroactive coverage back to the date of termination from Medicaid (no earlier than January 1, 2023) or coverage beginning the month after the individual enrolls. If an individual selects retroactive coverage, they must pay the premiums for the retroactive covered time period.

Transitioning to employer coverage

  • Per Department of Labor guidance, plans and issuers must allow eligible employees and their dependents to enroll in employer coverage after losing eligibility for Medicaid or CHIP. Employees usually have 60 days after they lose eligibility in Medicaid or CHIP to request special enrollment in an employment-based plan.

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