Commercial Updates
Understanding the Medicaid Continuous Eligibility Unwind
At the beginning of the COVID-19 pandemic, the federal government declared a public health emergency (PHE) and took steps to require continuing Medicaid coverage even in the event of changing eligibility.
In December 2022, Congress passed the FY 2023 Consolidated Appropriations Act, separating the federal PHE and Medicaid’s continuous enrollment policy. This Act established April 1, 2023, as the end of the continuous enrollment requirement for Medicaid.
States are reviewing enrollee eligibility and will be disenrolling those identified as no longer eligible.
Below, you will find details on this Special Enrollment Period (SEP) triggered by the loss of Medicaid coverage, along with links to each respective state. Many members will qualify for coverage through the marketplace or their group coverage.
Utah
Federal Facilitated Marketplace (FFM)
Utah Department of Health & Human Services
The FFM will allow an SEP for those losing Medicaid coverage from April 2, 2023 to July 31, 2024. If a member has lost Medicaid coverage, they can apply for marketplace coverage anytime within this timeframe.
Idaho
YHI will allow a 60-day SEP window following the date Medicaid coverage will end. Consumers will be able to declare they have lost Medicaid coverage, which may be validated using the Department of Health and Welfare’s (DHW) records at a later date. Those whose records cannot be validated against DHWs records will be required to provide other documentation to support the loss of Medicaid coverage.
Nevada
NHL will allow a 60-day SEP window following the date Medicaid coverage will end. Consumers will be able to declare they have lost Medicaid coverage, which may be validated using Nevada Health Link records at a later date. Those whose records cannot be validated against Nevada Medicaid records will be required to provide other documentation to support the loss of Medicaid.
For questions or information on how to enroll directly with Select Health, please contact Individual Sales at 800-442-5306, option 2.
CAA RxDC Submission Deadline: May 5, 2023
We are helping our mutual clients (large and small employer groups) meet the prescription drug reporting requirements of the Consolidated Appropriations Act (CAA). Reporting this drug pricing data to the Centers for Medicare and Medicaid Services (CMS) will help the public know more about the cost of prescription medications.
When is the deadline?
Communication was sent to agents via Agent Alert on March 23, 2023, with the details of what we need in order to report accurate group information. As a reminder, for reporting year 2022, clients should submit their data no later than May 5, 2023, so that Select Health can send the drug pricing information to CMS by the CAA’s June 1, 2023 deadline. Data will not be accepted after May 5. If we do not receive each group’s data, we will be unable to assist with meeting this reporting requirement.
How can you best support your groups?
Select Health is reaching out to groups directly to complete this process, but you can assist us by checking in with your groups to ensure they have submitted the necessary information and answer any questions they may have. Thank you for your continued support as we fast-approach the deadline of May 5, 2023.
Questions?
Please contact your account manager.