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Millions of consumers may soon be eligible for Marketplace coverage, and you should be ready to assist them! Beginning April 1, 2023, states will be able to terminate Medicaid enrollment for individuals who are no longer eligible for coverage. Many consumers who lose Medicaid coverage will be directed to apply for coverage through the Marketplace.
Background: To keep people in coverage during the COVID-19 Public Health Emergency (PHE), under what is known as the “continuous enrollment condition,” states paused terminations for Medicaid coverage as of March 2020.* States would then be required to resume regular eligibility and enrollment operations, including renewals and coverage terminations, when the PHE eventually ended – a process commonly referred to as “Unwinding.”
A recent law provides a date certain for Unwinding to begin.** The “continuous enrollment condition” will now end on March 31, 2023, with states able to begin to terminate Medicaid enrollment for individuals no longer eligible on April 1, 2023. States will then have up to 14 months to complete a renewal for all individuals in their programs. Redeterminations can begin as early as February 1 with the first terminations effective on April 1. People who receive advance notice of an April 1 termination may start enrolling immediately to ensure continuity of coverage.
What you can do: Agent and broker assistance is important in making sure these consumers maintain health coverage throughout this period. You can use this opportunity to grow your book of business or gain referrals and connections. Agents and brokers should prepare for the Unwinding Period just as they would for Open Enrollment.
- Agents and brokers must register and complete training prior to assisting consumers on the Marketplace. Sign up for or update your information on Find Local Help and ensure your contact information and training on Help On Demand is up to date so new consumers, including those no longer eligible for Medicaid, can reach you. Your Find Local Help and Help On Demand profile settings are linked to your Marketplace Learning Management System (MLMS) profile. Ensure your MLMS profile and settings are up to date.
- Ensure you have sufficient staff to assist the increased number of consumers during the entire Unwinding Period.
Stay Up to Date on Unwinding: The Marketplace will continue to share updates and information for agents and brokers throughout the coming months regarding the Unwinding Period.
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Stay tuned for upcoming webinars: The Centers for Medicare & Medicaid Services (CMS) will be hosting several webinars and informational sessions. Keep an eye on your email and other agent/broker communication channels for more information.
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Bookmark the general resources website: The CMS General Resources page posts key technical assistance resources, outreach and education resources, trainings, and more. This page will be updated with new resources on Unwinding as they are available.
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Review guidance from your State Medicaid Agency: Each state will be conducting its own Unwinding process. Agents and brokers should continue to review guidance posted on the Medicaid.gov Unwinding and Returning to Regular Operations after COVID-19 website.
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Review guidance from CMS: To learn more about Unwinding, see this CMS Informational Bulletin.
Have additional questions? Contact the Agent/Broker Email Help Desk at FFMProducer-AssisterHelpDesk@cms.hhs.gov.
* Under section 6008(b)(3) of the Families First Coronavirus Response Act (FFCRA), states claiming a temporary 6.2 percentage point increase in the Federal Medical Assistance Percentage (FMAP) have been unable to terminate enrollment for most individuals enrolled in Medicaid as of March 18, 2020, as a condition of receiving the temporary FMAP increase. While the requirements of section 6008 of the FFCRA do not apply to separate the Children's Health Insurance Program (CHIP) or the Basic Health Program (BHP), CMS recognizes some states elected to apply certain provisions of section 6008 to their separate CHIP program or BHP. In those circumstances, subject to exceptions noted and other federal requirements, guidance related to unwinding from the Medicaid continuous enrollment condition also applies to CHIP and BHP.
** On Thursday, December 29, 2022, the Consolidated Appropriations Act, 2023 (CAA, 2023) was enacted. The newly enacted CAA, 2023 does not address the end date of the PHE, and as of January 2023, the PHE is still in effect; it does, however, address the end of the continuous enrollment condition, the temporary FMAP increase, and the unwinding process.
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