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Medicaid Redetermination

Redetermination “Unwinding”

Are you a Medicaid member that will be losing eligibility now that the COVID-19 PHE has ended? The Centers for Medicare & Medicaid Services (CMS) have set a Marketplace Special Enrollment Period (SEP) for qualified individuals and their families who lose Medicaid or CHIP coverage due to the end of the COVID-19 PHE continuous enrollment condition. This SEP is also known as Medicaid “unwinding.”

This Unwinding SEP will allow individuals and families in Marketplaces served by to enroll in a Marketplace plan outside of the annual Open Enrollment period. CMS will update so that Marketplace-eligible consumers who submit a new application or update an existing application between March 31, 2023 and July 31, 2024, and attest to a last date of Medicaid or CHIP coverage within the same time period, are eligible for an Unwinding SEP. Consumers who are eligible for the Unwinding SEP will have 60 days after they submit their application to select a Marketplace plan with coverage that starts the first day of the month after they select a plan.

Example: If the member loses Medicaid eligibility in May 2023, they could apply in April 2024, and attest to losing coverage in May 2023. Their 60 days to choose a plan starts in April 2024, on the date they applied for Marketplace coverage.

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