May 22, 2024

Normally, anyone enrolled in Medicaid or CHIP is required to demonstrate their ongoing eligibility for those benefits with regular reviews.  However, as you may have noticed, the last three years have been anything but normal.

Beginning March of 2020, due to the pandemic, the federal Center for Medicare & Medicaid Services (CMS) waived the requirements for eligibility review for enrollees in Medicaid and CHIP. That means that anyone enrolled in either of those programs in March of 2020 could continue with those benefits without demonstrating eligibility for the duration of the national emergency.

The national emergency officially ends July 10, 2023. So what happens now?

First, what’s not happening: All current Medicaid and CHIP enrollees aren’t having their eligibility reviews all at once.  Instead, current enrollees will be scheduled for their eligibility reviews gradually over the twelve months following July 10, 2023.  (That’s why it’s called the “Medicaid Unwinding,” not the “Medicaid Asteroid Strike.”)

A determination that one is no longer eligible for Medicaid or CHIP is a “qualifying event,” like any other involuntary loss of coverage.  As such, that person is eligible to enroll in available group coverage or in individual coverage; if group coverage isn’t available, that person may also be eligible for a subsidy through Healthcare.gov.

Enrollment in new coverage needs to take place within 60 days of loss of Medicaid or CHIP eligibility, the same as with any other loss of coverage. And of course, the government loves its paperwork, so the need for an eligibility review, the materials needed to show eligibility, the deadlines for submission, etc., as well as the final determination of eligibility will all be communicated via mailed notices, so no one will be taken by surprise.

Need help navigating Healthcare.gov for your individual coverage? Let us help.

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