Health Alliance: Individual ACA & Individual Marketplace Plan Unwinding SEP

During the COVID public health emergency, Medicaid redetermination was put on hold. Legislation passed in December 2022 under the Consolidated Appropriations Act that calls for the pause on Medicaid redetermination to end on March 31, 2023. Beginning April 1, 2023, states will be able to terminate Medicaid enrollment for individuals no longer eligible.

As a result, CMS has updated HealthCare.gov so Marketplace-eligible consumers who submit a new application or update an existing application between March 31, 2023 and July 31, 2024 (16 months), and attest to a last date of Medicaid or CHIP coverage within the same time period, are eligible for a Special Enrollment Period (SEP) known as the “Unwinding SEP”.

Consumers who are eligible for the Unwinding SEP for Health Alliance^™Marketplace plans:

• Do not have to wait for their Medicaid or CHIP coverage to end before submitting an application for Marketplace coverage.
• May report that loss of coverage up to 60 days before their last day of Medicaid or CHIP coverage.
• 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.

These same consumers may alternatively apply for Health Alliance Direct plan coverage with no change to the existing application process. Enrollees onto Health Alliance Direct plans continue to be subject to Health Alliance Direct SEP timeframes and document submission requirements outlined in the Special Enrollment Period brochure. Click here for the brochure.

If you have any questions, call us today at 866-568-9649!