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Thursday, May 12, 2016

New CMS Requirements Make It Harder to Qualify for a “Permanent Move” SEP

Kara Nester

Policy Analyst

Last week, CMS announced some changes to special enrollment periods for the health insurance marketplaces. We were disappointed to see that CMS is tightening the rules that allow people who are moving permanently to qualify for an SEP.

To be eligible for the permanent move SEP, the new rule now requires consumers to have minimum essential coverage for at least one of the 60 days before they move. This changes the current rule that allows any consumer to enroll in coverage if they move to a new service area, regardless of having prior coverage.

All SEP changes go into effect on July 11 and will apply to all marketplaces.

We are concerned about how these changes will affect consumers and will be submitting comments to CMS. Comments are due by July 5, 2016.

Some people are exempt from the requirement for prior coverage

CMS published an updated factsheet to correspond with the new guidelines. There are exceptions to the new requirement for prior coverage for the following individuals:

  1. Consumers who are moving from another country
  2. Consumers who were previously incarcerated
  3. Individuals who are moving from a state that has not yet expanded Medicaid and are newly eligible for tax credits

Changes to the timeline for states to implement these new policies

CMS also announced changes to the implementation timeline for:

  • Providing advance availability of the permanent move SEP, which would allow consumers to apply for the permanent move SEP 60 days prior to a move.
  • Providing a new a SEP for loss of a dependent, or for those no longer being considered a dependent (due to divorce, legal separation, or death).

All marketplaces, including state-based marketplaces, were previously required to have had these policies and processes in place by January 1, 2017. With this new rule, implementation of these policies will be at the option of the marketplaces. CMS has given no indication whether the federally facilitated marketplace will retain these SEP options or the original timeline for implementation.

To help us prepare comments about the impact these changes will have on consumers, please share your reactions and comments to this by emailing us at assisters@familiesusa.org.

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