HHS takes additional actions to help #MedicaidUnwinding population stay covered including extending SEP

(Note: This was actually announced the day before CMS posted the December Medicaid Unwinding transition data.)

Via the Centers for Medicare & Medicaid Services (CMS):

HHS Extends Special Enrollment Period to Help People Transition to the Marketplaces, Issues New Resources for Partners, and Publishes Guidance Reinforcing Key Federal Requirements

Today, the U.S. Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS), announced additional actions it is taking to help people maintain coverage as states continue Medicaid and Children’s Health Insurance Program (CHIP) eligibility renewals, which restarted across the country last spring following a pause during the COVID-19 pandemic. Today’s actions will continue and extend a previously announced flexibility to make it easier for people to transition to Health Insurance Marketplace coverage through 2024, help more people with Medicaid and CHIP navigate renewals, and reinforce important federal requirements that are crucial for protecting coverage in states during and beyond “Medicaid unwinding.” 

CMS is extending a temporary special enrollment period (SEP) to help people who are no longer eligible for Medicaid or CHIP transition to Marketplace coverage in states using HealthCare.gov. The end date of this “Unwinding SEP” will be extended from July 31, 2024, to November 30, 2024, which will help more people leaving Medicaid or CHIP secure affordable, comprehensive coverage through the start of the next open enrollment period. This extension will be crucial to ensuring people remain covered, including in states that have given people additional time to renew their coverage, as CMS has recommended, to help eligible people stay enrolled. States with state-based Marketplaces can adopt similar extensions.

I honestly admit to not really getting the point of this SEP the first time it was announced, since anyone who loses Medicaid or CHIP coverage already has a 60-day SEP to begin with; I can't imagine that too many people are going to way more than 2 months after getting kicked off of their healthcare coverage to see what their options are. Then again, that might be a privileged (or at least naive) perspective; presumably they wouldn't have announced the 14-month SEP for the Unwinding population in the first place unless it was needed, nor would they be bumping it out by another four months now if it wasn't. Fair enough.

“The actions we are announcing today, like those we have taken over the past year, demonstrate that HHS is committed to ensuring Medicaid and CHIP coverage for all who are eligible. We are helping those who will now qualify for Marketplace coverage obtain it,” said HHS Secretary Xavier Becerra. “We encourage states to use all the strategies and resources we have provided them to carry out renewals of coverage. We will continue to monitor the renewal process and make sure federal requirements are being followed.”

“Protecting and strengthening access to health coverage in Medicaid, CHIP, and the Marketplaces is a top priority,” said CMS Administrator Chiquita Brooks-LaSure. “Today’s steps will help make sure more families stay connected to the health care they need to thrive.” 

CMS also released new guidance and other resources to help protect coverage. These include: 

• Guidance on unwinding processes and tools for states reinforcing important federal renewal requirements that states must follow, developed in response to questions from both states and partners;

• Guidance to Medicaid managed care plans on completing signatures for enrollees so plans can help more people renew coverage; and

• New resources for partners to help families navigate their state Medicaid fair-hearing process, such as if someone was determined no longer eligible for Medicaid.

HHS continues to urge states to take up proven federal strategies that help more eligible people renew coverage and stands ready to support states in improving their renewals systems. As detailed in a new case study from the U.S. Digital Service (USDS), CMS partnered with USDS to engage with states across the country to reduce red tape, increase auto-renewal (ex parte) rates, address systems problems like the auto-renewal issue identified across 29 states last fall, and take up the dozens of strategies developed by CMS to help keep eligible children and adults covered.

These efforts have helped increase auto-renewal rates nationally by about 85% – from about 25% in April 2023 to 47% in December 2023 and 46% in January 2024, as reported in the monthly Medicaid and CHIP renewals data published today. As just one state example, California increased auto-renewal rates from an average of about 34% from June 2023 to November 2023 to 66% in December 2023 after adopting CMS strategies and engaging with CMS and USDS. 

Today’s actions build on the steps HHS and CMS have taken over the last year to protect health coverage during renewals, including making nearly two dozen strategies available to states to help eligible people renew Medicaid and CHIP, approving nearly 400 of these strategies across the country, conducting extensive outreach and advertising to raise awareness about renewals, creating a one-stop shop of federal resources on renewals for partners, and holding states accountable to federal Medicaid and CHIP renewal requirements.

In addition, yesterday, CMS finalized a rule that builds on key lessons during Medicaid unwinding by streamlining and simplifying how people enroll in and renew Medicaid and CHIP coverage going forward. For example, while families in some states have faced barriers when transitioning a child’s coverage from Medicaid to CHIP during the unwinding process, this rule will require all states to make this transition more seamless in the future. This and other changes will help to ensure that millions of eligible children and adults can get and keep their coverage.