By: HUB’s EB Compliance Team
As COVID-era relief ends, one that is perhaps less obvious to most employers is Medicaid redeterminations. Under various COVID relief laws, states were required to keep individuals who were enrolled in Medicaid on Medicaid until the end of March. As a result, many people who might otherwise have lost Medicaid eligibility since 2020 have remained on Medicaid.
States will start evaluating their Medicaid roles in April 2023. While not all states will make determinations simultaneously, over the ensuing months, individuals who are no longer eligible for Medicaid will be looking for other coverage.
Special Enrollment Rights
Under HIPAA special enrollment rights, group health plans are required to allow eligible employees and their dependents to enroll in group health plan coverage within 60 days after a loss of Medicaid eligibility. This is mandatory provision, so all group health plans (other than excepted benefits) are required to offer this. Therefore, employers with substantial Medicaid-eligible populations should anticipate requests for enrollment starting in April 2023 and likely spreading into 2024 in some cases.
Those who lose Medicaid eligibility will also have a separate ACA exchange special enrollment right, which allows them to enroll in individual coverage through an ACA exchange. Since the family glitch has been removed, this could result in spouses and children who might otherwise enroll in an employer’s plan now enrolling in individual exchange coverage if the cost of family coverage is not affordable. This is unlikely to impact employee enrollment so long as the employer offers affordable, minimum value coverage to the employee.
Takeaways
Employers may want to brush up on their process for accepting these special enrollment applications and share that with employees who might receiving inquiries about group health plan coverage. Some employers could also consider sending out a communication internally, although if the employer has been sharing special enrollment rights as part of its standard plan communications, a separate communication is likely not required.
If you have any questions, please contact your HUB Advisor. View more compliance articles in our Compliance Directory.
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Neither Hub International Limited nor any of its affiliated companies is a law or accounting firm, and therefore they cannot provide legal or tax advice. The information herein is provided for general information only, and is not intended to constitute legal or tax advice as to an organization’s or individual's specific circumstances. It is based on Hub International's understanding of the law as it exists on the date of this publication. Subsequent developments may result in this information becoming outdated or incorrect and Hub International does not have an obligation to update this information. You should consult an attorney, accountant, or other legal or tax professional regarding the application of the general information provided here to your organization’s specific situation in light of your or your organization’s particular needs.