Outside of open enrollment, consumers still have the opportunity to enroll in qualified health plans when they experience certain life changes, such as marriage or a permanent move to an area with new coverage options. These opportunities to enroll outside of open enrollment are called special enrollment periods, or SEPs.
Recently the Obama administration released new standards governing Medicaid managed care plans. These managed care rules haven’t been updated since 2002, and a lot has changed in the past 14 years. There are currently over 72 million people enrolled in Medicaid, and three-quarters are enrolled in managed care.
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The first in a series of short analyses explaining certain provisions of the sweeping new standards issued by the Obama administration to guide the operation of state Medicaid managed care plans. Here, we look at changes affecting the enrollment process.
The Obama administration recently took steps to help people leaving prison or jail get health coverage more easily. Last month, the Centers for Medicare and Medicaid Services (CMS) released a long-awaited clarification regarding health coverage for people involved with the criminal justice system. Through this guidance, CMS seeks to expand health coverage options for those who’ve recently been released from incarceration.
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 to allow for 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. Previously, consumers could enroll upon moving without having prior health insurance.
Every day around the country, enrollment assisters help consumers get enrolled and stay enrolled in health coverage. This work provides assisters with a unique perspective on the consumer’s experience with the health care system. And it puts assisters in an ideal position to educate public officials about the enrollment process and to share their ideas for improving it.
After the close of each open enrollment session, enrollment assisters often debrief with each other to discuss what worked and what lessons they learned about successful enrollment. In several debrief meetings we joined recently around the country, discussion frequently touched on the increasing complexity of consumers’ needs and assisters’ growing interest in professional development.
As members of the enrollment team at Families USA, we were invited to help plan and facilitate some of these debrief meetings. Reflections about lessons learned from the last open enrollment were a crucial component of those meetings, but many also used this time to look ahead and plan for next year.
Earlier this week, CMS offered welcome clarification on special enrollment periods (SEP) for people in the coverage gap. It also issued updates about eligibility determination notices and hardship exemptions. We explain the updates below.
On Wednesday, CMS clarified the procedure for the special enrollment period (SEP) for consumers who move out of the “coverage gap.” People who are in the coverage gap live in states that have not expanded Medicaid.
We know you have a lot going on, and there isn’t always time to read everything. That’s why we’ve rounded up five of our most popular blogs published between January and March of this year.