As of April 2023, states were able to resume Medicaid redeterminations and terminations of coverage for those no longer eligible, potentially putting millions of individuals at risk of losing coverage.
Individuals at risk included those who no longer meet eligibility requirements or who have failed to complete the redetermination process. Although many may qualify for other types of insurance coverage, individuals with serious mental illness (SMI) and substance use disorders (SUDs) are particularly affected by this change.
Three key things you should know about the change:
- State Medicaid agencies must follow criteria and make good-faith efforts to notify Medicaid beneficiaries before disenrollment.
- The Centers for Medicare and Medicaid Services (CMS) announced additional guidance for qualified individuals and their families to enroll (outside the original enrollment window) in marketplace health insurance.
- CMS released the Marketplace Notice of Benefit and Payment Parameters, which states that marketplaces will have the option to implement a rule for consumers losing Medicaid and CHIP, which is also considered minimum essential coverage. This rule allows the consumer 60 days before or 90 days after the loss of coverage to select a plan for marketplace coverage.
SOURCE: The “Unwinding” of the Medicaid Continuous Enrollment Condition: 3 Things to Know (psychiatrictimes.com)