Last week the Centers for Medicare & Medicaid Services (CMS) released a State Health Official (SHO) letter outlining new requirements in the Consolidated Appropriations Act, 2023 that impact state activities for the Medicaid and CHIP (Children’s Health Insurance Program) programs to unwind from the COVID-19 public health emergency. The SHO letter also addresses changes to the conditions which states must meet to receive increased federal medical assistance percentage (FMAP), reporting requirements, and new enforcement authority for CMS to ensure state compliance with eligibility redetermination and reporting requirements. 

In addition, CMS released information on a temporary Exceptional Circumstances Special Enrollment Period (SEP) for consumers losing Medicaid or CHIP coverage due to unwinding of the Medicaid continuous enrollment condition. From March 31, 2023 through July 31, 2024, the Marketplaces using the Federal platform will be providing additional flexibility for Marketplace-eligible consumers losing Medicaid or CHIP to enroll in Marketplace coverage during and immediately following the end of the Medicaid Continuous Enrollment Condition unwinding period. This flexibility will be provided by facilitating access on HealthCare.gov to an SEP, referred to as the “Unwinding SEP.”

CMS previously announced a Medicare Special Enrollment Period to help individuals who did not sign up for Medicare on time and lose Medicaid coverage. This new SEP helps promote seamless transitions from Medicaid to Medicare coverage and removes Medicare late enrollment penalties. More information on Medicare Special Enrollment Periods can be found here.