The unwinding related section 1902(e)(14) strategies newly available to Medicaid and CHIP agencies can provide significant relief to states facing pending eligibility and enrollment actions and processing delays, workforce and systems limitations, and other operational challenges. Ensuring eligible individuals do not lose coverage for procedural or administrative reasons and supporting those who are ineligible for Medicaid/CHIP transition to Marketplace coverage will be paramount for all states as they begin to resume normal operations when the federal public health emergency (PHE) ends. This expert perspective outlines the time-limited targeted enrollment flexibilities that CMS has availed to states through section 1902(e)(14) waiver authority and discusses considerations beyond the strategies described in federal guidance and supplemental resources.
Creating Seamless Coverage Transitions between Medicaid and the Exchanges
Center for Health Care Strategies – Carolyn Ingram, Shannon M. McMahon, and Veronica Guerra
Under health reform, Medicaid will expand in 2014 to cover an additional 16 to 20 million beneficiaries. This population will include a significant percentage of childless adults with urgent and complex health care needs, who are likely to shift between subsidy programs over time. This brief, prepared by the Center for Health Care Strategies, draws from current state programs that have dealt with this challenge successfully. The experiences described herein can help states develop policies and procedures that foster seamless coordination of care during coverage transitions between Medicaid managed care organizations and qualified health plans in the exchanges. A companion matrix includes excerpts of sample contract language related to coverage transitions in existing programs.