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On July 20, 2023, the Centers for Medicare and Medicaid Services issued an open letter to employer plan sponsors and health plan issuers requesting that they amend their group health plans to allow a temporary enrollment extension for individuals who are losing coverage under the Medicaid or CHIP programs.

Background

• Coverage terminations under Medicaid and the Children’s Health Insurance Program (CHIP) were paused during the COVID-19 pandemic. Eligibility reviews were not required in order for covered individuals to maintain their coverage.
• The relief from normal Medicaid and CHIP eligibility and enrollment processes expired on March 31, 2023 with the passage of the 2023 Consolidated Appropriations Act.
• As states review their Medicaid and CHIP enrollee eligibility for the first time since the start of the COVID-19 pandemic, many individuals are expected to lose their eligibility and need to transition to a different type of coverage.
• Normally, individuals who lose eligibility for Medicaid or CHIP have a minimum special enrollment period of 60 days in which to enroll in their employer group health plan.
• With the number of individuals expected to lose coverage under Medicaid and CHIP within a short period of time as states resume normal processes, CMS and the Departments of Treasury and Labor are concerned that many may not immediately be aware that they have lost coverage. As a result, these individuals may need more than 60 days to enroll in new coverage.

CMS Recommendations

• CMS has announced that they will be offering a temporary enrollment period, from March 31, 2023 to July 31, 2024, for individuals who lose coverage under Medicaid or CHIP and wish to enroll in new coverage on an Exchange.
• Employer plan sponsors are urged (but not required) to amend their group health plans to temporarily allow a similar enrollment extension for individuals who lose their coverage under Medicaid or CHIP and seek to enroll in employer-sponsored coverage.
• Enrollment would be on a prospective basis only.
• CMS has provided resources to facilitate employer communications with employees regarding post-pandemic changes to Medicaid and CHIP.