Full Answer
What are the requirements for continuing Medicaid coverage?
To qualify for continuing Medicaid coverage, a person must: Have been eligible for an SSI cash payment for at least 1 month; Still meet the disability requirement; and Still meet all other non-disability SSI requirements; and
What happens if the state terminates your Medicaid?
If the state terminated a Medicaid recipient’s benefits after March 18, 2020, the state must make a good faith effort to contact the recipient and encourage him or her to reenroll. States may terminate coverage for individuals who request to be terminated or who are no longer residents of the state.
Who is eligible for temporary continuation of coverage?
Title II of Public Law 100-654, effective January 1, 1990, established the temporary continuation of coverage provision for the FEHB Program. An employee, a child, and a former spouse are eligible for temporary continuation of coverage based on specific qualifying events.
What is temporary continuation of coverage under FEHB?
Temporary Continuation of Coverage If the enrollee loses FEHB coverage because he/she separates from Federal service, he/she may enroll under the Temporary Continuation of Coverage (TCC) provision of the FEHB law to continue his/her coverage for up to 18 months from the date of separation.
How long is continuous eligibility for Medicaid?
States Providing Continuous Eligibility. The following States provide 12-month continuous eligibility for Medicaid and/or CHIP; the exceptions are specified. Some states include exceptions to their continuous eligibility period and may also limit it to a subgroup of their CHIP eligible population.
How long can a child be on Medicaid?
States have the option to provide children with 12 months of continuous coverage through Medicaid and the Children's Health Insurance Program (CHIP), even if the family experiences a change in income during the year. Continuous eligibility is a valuable tool that helps states ensure that children stay enrolled in the health coverage ...
Why is continuous eligibility important?
Continuous eligibility is a valuable tool that helps states ensure that children stay enrolled in the health coverage for which they are eligible and have consistent access to needed health care services.
Why is stable coverage important?
Stable coverage also enables doctors to develop relationships with children and their parents and to track their health and development. Additionally, eliminating the cycling on and off of coverage during the year reduces state time and money wasted on unnecessary paperwork and preventable care needs.
How long does a family member lose TCC?
loses coverage after 12 months in a leave without pay status; is a compensationer and loses coverage because the compensation terminates; is a family member who loses coverage when the enrollee changes to a Self Only enrollment, cancels coverage, or separates from service and the family member does not elect TCC;
When does a carrier have to grant an extension?
The carrier must grant an extension if the terminating individual shows proof of guaranteed-issue conversion coverage with an effective date after the initial 31 day extension of coverage period. If that proof is not available, carriers may also grant extensions if an individual shows other good cause.
How long does a FEHB policy last?
However, if an individual timely purchases guaranteed-issue insurance coverage on or off the Exchange, as opposed to a conversion policy offered by an FEHB Program carrier, the effective date of the conversion coverage may be more than 31 days after the termination of his or her FEHB coverage. In the event this 31-day temporary extension period provides insufficient opportunity for the enrollee to exercise his or her right to convert to a guaranteed-issue non-group contract with an effective date commencing before or immediately upon the end of the 31-day temporary extension of coverage period, the Carrier may provide an additional extension of coverage not to exceed a total of 60 days as appropriate to avoid an interruption in coverage.
What happens if you are erroneously enrolled in a non-group contract?
If he/she was erroneously enrolled and premium withholdings and contributions were made, the employing office must terminate coverage and discontinue withholdings and contributions at the end of that pay period . No adjustments are made for contributions and withholdings that already have been made. The enrollee and his/her covered family members are entitled to full plan benefits during the time they were erroneously enrolled. He/she is entitled to convert to a non-group contract the same as any other employee whose enrollment is terminated.
How long is a self plus one extension?
An enrollee or family member whose enrollment is terminated other than by cancellation or discontinuance of the plan is entitled to a 31-day extension of coverage for self only, self plus one, or self and family without contributions by the enrollee or the Government.
What happens if you are excluded from FEHB?
If the enrollee's position is excluded from FEHB coverage but he/she was erroneously allowed to enroll, his/her employing office must terminate or void the coverage as soon as the error is discovered . The employing office must explain to him/her why he/she is not eligible for coverage and the effect of the termination.
When does a conversion contract become effective?
The enrollee or his/her family member's conversion contract becomes effective at the end of the 31-day extension of coverage, even when the enrollee or his/her family member is an inpatient in a hospital on the 31st day of extended coverage.
Medicaid Redeterminations Create a Risk for Coverage Loss
Medicaid redeterminations have always been a source of coverage losses among eligible people because of paperwork barriers. Affordable Care Act rules aimed at reducing inappropriate terminations were adopted by states and have led to less churning. However, we’ve also seen significant coverage losses when large numbers are being renewed.
A Perfect Storm
Several factors are converging to make the upcoming Medicaid eligibility redeterminations extraordinarily risky. Medicaid enrollment has grown sharply during the pandemic.
Now Is the Time to Act
We need to plan for and implement strategies to prevent unintended coverage loss. An array of strategies has been identified by CMS. While a state’s blueprint will depend on policies and IT capabilities, they should consider these three strategies:
Conclusion
Continuous Medicaid enrollment has allowed people — including many people of color — to retain coverage and get needed care during the pandemic. When the requirement ends, most people will likely continue to be eligible for either Medicaid or marketplace coverage, but a massive number of renewals will test the system.
