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HIPAA Special Enrollment Requests To Increase Due to Loss of Medicaid Eligibility

April 25, 2023

Beginning April 1, 2023, states that maintained continuous Medicaid enrollment during the COVID-19 pandemic may start terminating coverage for individuals who are no longer eligible. Employers will likely see an increase in midyear enrollment requests as individuals lose eligibility for Medicaid or Children’s Health Insurance Program coverage.

To receive additional federal funding, many states maintained continuous enrollment for individuals enrolled in Medicaid during the COVID-19 pandemic, despite any changes in eligibility status. Medicaid’s continuous enrollment requirement ended on March 31, 2023. While some individuals who lose Medicaid or CHIP eligibility will enroll in coverage through a health insurance marketplace, federal regulators estimate that 5 million people will seek coverage under employer-sponsored health plans.

Privacy laws require group health plans to provide special enrollment opportunities in certain situations, including when employees or their dependents lose eligibility for Medicaid or CHIP coverage. Employees normally have 60 days to request special enrollment, but this deadline was extended during the COVID-19 national emergency. Read more from ABC Insurance Trust and learn what actions employers should take.

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