Policy Changes for Post Public Health Emergency (PHE)

News & Media

Policy Changes for Post Public Health Emergency (PHE)

Tuesday, May 2, 2023

MSMS is monitoring COVID-19 testing, treatment and telehealth policy changes. Policies are still evolving, and information will be updated as it becomes available.

It is important to keep checking third party payer websites for updates as the information may be posted on the payer websites before being published in payer newsletters.

Medicaid Eligibility Redeterminations - Unwinding

CMS has announced a temporary Special Enrollment Period (SEP) for qualified individuals and their families who are losing Medicaid or CHIP coverage due to the end of the continuous enrollment condition. During this process, known as “unwinding,” millions of individuals could lose their Medicaid or CHIP coverage and need to transition to other forms of coverage, including through the Marketplaces.

Due to the volume of individuals who could lose their Medicaid or CHIP coverage, state Medicaid and CHIP agencies may be unable to provide timely information about the termination of coverage and alternative plan options that would enable consumers to make an informed decision about their health care coverage options within 60 days. For example, a consumer may need clarity as to whether a loss of Medicaid or CHIP coverage was procedural, such as a failure to update information, or due to ineligibility, before deciding whether to pursue Marketplace coverage.

Additionally, many Medicaid and CHIP beneficiaries may have moved or changed addresses since last receiving communications from their state. As a result, they may not receive termination notices from their state Medicaid or CHIP agency within 60 days or at all. Given these exceptional circumstances, CMS has made this SEP, also referred to as the “Unwinding SEP,” available so consumers can maintain coverage.

The Unwinding SEP will allow individuals and families in states with Marketplaces served by the HealthCare.gov platform to enroll in Marketplace coverage. Marketplace eligible consumers who submit a new application or update an existing HealthCare.gov application between March 31, 2023, and July 31, 2024, and attest to a last day of Medicaid or CHIP coverage during the same time period will be eligible for the Unwinding SEP. Consumers who are eligible for the Unwinding SEP will then have 60 days after they submit their application to select a plan with coverage that will start on the first day of the month after they select a plan. Consumers will not be required to submit documentation of a qualifying life event to receive the Unwinding SEP.