Home Compliance What Are Medicaid Redeterminations and Why Do They Matter to Employers?

What Are Medicaid Redeterminations and Why Do They Matter to Employers?

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What is Medicaid redetermination and why is it important to employers?

If you look at the recent blazing news about Medicaid redetermination (a.k.a. “Medicaid rollback”), you may automatically associate it with individuals, with some employees declining company benefits during the pandemic. You may not be aware that you may have signed up for Medicaid by doing so.

Medicaid is a joint federal and state program that provides medical coverage for certain low-income adults, children, pregnant women, seniors, and persons with disabilities. Each state administers its own Medicaid program. Individuals applying for Medicaid must provide documents and information to qualify. This differs from traditional health insurance where coverage continues as long as the premium is paid. Medicaid’s annual renewal process includes redetermination. This means individuals must reapply for Medicaid each year. If someone loses Medicaid eligibility, that person is no longer eligible for health insurance and must obtain health insurance elsewhere.

In 2020, a law was passed to suspend the regular annual redetermination process due to the pandemic. This suspension eliminates the need for the individual to reapply every 12 months and maintains Medicaid eligibility until the public health emergency (PHE) ends or other legislation is passed. will be a spoiler alert – PHE is set to end on May 11th, 2023. However, in December 2022, the Consolidated Appropriations Act (an annual budget with a number of appropriation bills thrown in) is passed, after which the suspension of Medicaid redetermination from the end of PHE is lifted, returning the state to its normal course. was assigned a timeline for re-determined business

States have 14 months to complete the redetermination of Medicaid participants beginning April 1, 2023. States can start reviewing paperwork and submitting requests now, but they can’t fire anyone from Medicaid by April 2023. Don’t worry.

Why is Medicaid redetermination important for employers?

Employees who are eligible for employer benefits but decline because they are eligible to enroll in Medicaid may become ineligible during the Medicaid redetermination process. This results in a special registration period and employers should be familiar with the process.

Special Enrollment Period means that an Eligible Employee may sign up for or change coverage for Eligible Events outside of an employer’s normal Open Enrollment where the Eligible Employee may change enrollment or coverage. Any time. Loss of Medicaid eligibility is a qualifying event regardless of whether the loss applies to the employee or an eligible spouse or dependent. The employee, spouse, or eligible dependent in this situation must actually be eligible for employer compensation as outlined in the Affordable Care Act and employer planning documents. Note that there is

Disqualified employees must notify their employer of the event within 60 days and request registration. Once notified, employers should be prepared to provide registration materials and educate employees on what is available. Registration must be made by the 1st day of the month following the timely registration request. Apart from that, there are several documents and notices that new registrants are required to provide under several different laws. Required notices include summary plan description, benefit and coverage summary, uniform glossary, etc.

Employees often look to their employers for help and guidance regarding benefits. Employers are not responsible for educating employees about Medicaid, but it is important to have a clear understanding of what a Medicaid redetermination means and the employer’s potential role. This enables proper support for employees and ensures that employers comply with the laws, rules and regulations governing employee benefits.

Author: Angela Sula, CIC, CISR, SHRM-CP is a Principal Benefit Expert at Minerals.


DELTA Data Protection & Compliance, Inc. Academy & Consulting – The DELTA NEWS – Visit: delta-compliance.com

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