The Medicaid Unwinding of 2023
The Medicaid Unwinding of 2023
A Medicaid unwinding refers to the process of reducing or ending Medicaid expansion, which is the process by which states increase eligibility for Medicaid, the joint federal and state program that provides healthcare coverage to low-income individuals and families. This can happen when a state that had previously expanded Medicaid coverage decides to roll back those expansions, resulting in fewer people being eligible for the program. This can occur for a variety of reasons, such as budget constraints or changes in political leadership.
Did Virginia have a Medicaid expansion?
In 2019, the state of Virginia expanded Medicaid coverage to include individuals and families with incomes up to 138% of the federal poverty level. This expansion was made possible through the Affordable Care Act (ACA), which provided additional funding to states that choose to expand Medicaid coverage.
The specific rules of the Medicaid expansion in Virginia in 2019 included:
- Coverage for non-disabled adults between the ages of 19 and 64 with incomes up to 138% of the federal poverty level, who are not eligible for other Medicaid programs or for coverage through an employer
- A requirement for individuals to have a social security number and be a resident of the state to be eligible
- Coverage for certain essential health benefits, such as doctor visits, hospital stays, prescription drugs, and preventive care, among others
- No lifetime limits on benefits
- No cost-sharing for most individuals, like copays or deductibles,
- A requirement for individuals to renew their Medicaid coverage every 12 months
Virginia Medicaid Prepares for End to Federal Public Health Emergency
To keep people in coverage during the COVID-19 Public Health Emergency (PHE), under what is known as the “continuous enrollment condition,” states paused terminations for Medicaid coverage. However, the (PHE) will expire on March 31, 2023 – a process commonly referred to as “Unwinding.” At the end of the (PHE), states must return to normal enrollment operations and re-determine eligibility for Medicaid members. The Centers for Medicare and Medicaid Services (CMS) released guidance that describes timelines and obligations for states to follow as they implement this significant initiative.
The guidance gives states 12 months to initiate redeterminations and an additional two months for “clean up” for further processing efforts, for a total of 14 months. This implementation timeline enables states to resume normal operations efficiently and establish a redetermination schedule that is sustainable in future years.
It is estimated that 14-20% of the Commonwealth’s total Medicaid enrollees may lose coverage during the 14-month unwinding period. Some of these individuals are still eligible for Medicaid (they must go through the redetermination), the others may be eligible for coverage through the Federal Marketplace.
If I’m not eligible for Medicaid what are my Health Insurance options?
CMS has announced a Marketplace Special Enrollment Period (SEP) for qualified individuals and their families who are losing Medicaid coverage due to the end of the continuous enrollment condition — also known as “Unwinding.” Marketplace (ACA) -eligible consumers who submit a new application or update an existing application between March 31, 2023, and July 31, 2024, and attest that they have lost Medicaid or the Children’s Health Insurance Program (CHIP) coverage between these dates, are eligible for the Unwinding SEP.
To qualify for an Affordable Care Act (ACA) health insurance plan in Virginia, an individual or family must meet certain income, residency, and other eligibility requirements. These requirements are set by the federal government and are generally the same across all states.
In general, to qualify for an ACA health insurance plan in Virginia, an individual or family must:
- Not be eligible for Medicaid or other government-funded health insurance programs
- Be a resident of the state
- Be a citizen or legal permanent resident of the United States
How do I sign up for an ACA Marketplace plan?
Here at LCA Insurance Group we recommend contacting us to help guide you through the plan options and eligibility verification process.
Our consultations are no cost and no obligation. Call us today!
