Questions on Pending Applications from the Federal Marketplace
Some Virginians who previously had health insurance coverage through the Marketplace applied for Medicaid after the new eligibility rules took effect in November 2018. They have questions about their Medicaid enrollment status and the steps they should be taking now that we have entered 2019. This is a complicated topic, and we are devoting this edition of Partner Points to sharing answers and information that we hope will be helpful as you assist individuals in your communities. We also encourage you to visit HealthCare.gov to read information from the Centers for Medicare and Medicaid Services. These links (available in English and Spanish) provide detailed instructions about when and how to end Marketplace coverage, depending on your specific situation.
English: https://www.healthcare.gov/medicaid-chip/cancelling-marketplace-plan/
Spanish: https://www.cuidadodesalud.gov/es/medicaid-chip/cancelling-marketplace-plan/
If you are newly enrolled in Virginia Medicaid:
If you received a notice from either HealthCare.gov or the Virginia Department of Social Services stating that you have been determined eligible for Medicaid that counts as qualifying coverage, you should immediately end your Marketplace coverage with financial assistance if you have not already done so.
If you applied for coverage between November 1 and December 31, 2018, and received this notice about Medicaid eligibility, and did not take action to prevent automatic reenrollment in 2019 Marketplace coverage, your Marketplace plan was likely automatically renewed for 2019, but without financial assistance. You’re probably currently enrolled in full-cost Marketplace coverage and should end it if you don’t want to pay full cost for this coverage, and haven’t already ended it.
If your application is under review at Virginia Medicaid:
If you received a notice stating that your application has been referred to Virginia for review, you are being evaluated for Medicaid benefits. You may be contacted and asked for additional information to determine whether you are eligible.
If you applied for coverage between November 1 and December 31, 2018, and are waiting to hear if you’re eligible for Medicaid or your notice said you “may be eligible” for Medicaid and you didn’t take action to prevent automatic reenrollment in 2019 Marketplace coverage, your Marketplace plan was likely automatically renewed for 2019, with financial assistance. You’re probably currently enrolled in Marketplace coverage with financial assistance.
The Centers for Medicare and Medicaid Services recommend that individuals whose applications are under review keep their Marketplace coverage until they receive a final decision from Virginia stating that they are eligible for Medicaid.
If the final decision from Virginia is that you ARE eligible for Medicaid:
If you are found eligible for Medicaid, you will have retroactive Medicaid coverage that begins on the first day of the month you applied, but no earlier than January 1, 2019.
Once you receive notice of your eligibility for Medicaid, you should end your Marketplace plan with financial assistance; you are no longer eligible for this financial assistance. If there are multiple people on your Marketplace application and only some are eligible for Medicaid, end Marketplace coverage only for those who are Medicaid-eligible. You can reach the Marketplace Call Center at 1-800-318-2596 (TTY: 1-855-889-4325).
If the final decision from Virginia is that you are NOT eligible for Medicaid:
If you are found to be NOT eligible for Medicaid and you already ended your Marketplace plan, you may qualify for a Special Enrollment Period to enroll in Marketplace coverage with financial assistance, as applicable. You have 60 days from the date of your denial of Medicaid eligibility to enroll using the Special Enrollment Period, if eligible.
If you qualify for this Special Enrollment Period, the effective date for your Marketplace coverage will be the first day of the month after you enroll. You can also call the Marketplace Call Center at 1-800-318-2596 (TTY: 1-855-889-4325) to request a retroactive effective date that begins on the date that your Marketplace coverage would have started if you had originally been determined eligible for a Marketplace plan.
If you did not already end your Marketplace coverage, you can continue your current enrollment with financial assistance; be sure to update your Marketplace application with any changes (such as a change in your household size or income).
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