CMS to Employers: “Please Extend Special Enrollment Period”

CMS is urging employers to extend special enrollment periods for persons losing their Medicaid and CHIP coverage.

During the COVID public health emergency, terminations from the Medicaid program were paused to help provide medical coverage to individuals.  With the official end of the emergency period, the pause on Medicaid terminations has also ended and many individuals will be losing coverage.

Federal law requires health plans to provide a 60-day special enrollment period to eligible employees following loss of coverage under Medicaid or the Children’s Health Insurance Program (CHIP).  However, in an open letter, the Centers for Medicare & Medicaid Services (CMS), Treasury, and Department of Labor (DOL) (the Departments) expressed their concerned that, due to the “exceptional circumstances” of large numbers of people losing coverage, many individuals will need more time to enroll.  They note “employees may not realize that they have lost their Medicaid or CHIP coverage until they access care, since they may have missed notices from their state agency, and then missed their opportunity to enroll in other coverage.”

For example…

• Individuals who moved during the pandemic may not receive termination notices
• Others may not know the Medicaid renewals have restarted.
• Still others may face delays in processing applications for renewals due to backlogs at the state level.

Accordingly, the Departments are encouraging (but not requiring) employers to amend their group health plans to allow a special enrollment period for employees who have lost Medicaid or CHIP anytime between March 31, 2023 through July 31, 2024.

The Departments are also encouraging employers:

• to remind employees who are covered by Medicaid or CHIPS to update their contact information with the appropriate state agency; and
• make sure that employees who are not eligible for employer sponsored coverage are aware of the availability of free or low-cost coverage through the ACA Marketplaces.

Employers with fully insured plans will want to consult with their carriers regarding the letter.

Employers with self-insured plans should consider what actions, if any, they wish to take in response the Departments’ appeal.

The full text of the letter can be found here.

Additional resources can be found here.