Issue Briefs | Jan 19, 2023

Helping Consumers Navigate Medicaid, the Marketplace, and Employer Coverage

Tara Straw, Manatt Health and Julie Bataille, GMMB

The 2023 Consolidated Appropriations Act separated the Medicaid continuous coverage provision from the COVID-19 public health emergency and provided a fixed end date of March 31, 2023 for the Medicaid continuous coverage guarantee. Many consumers will find the relationship between Medicaid, the marketplace, and employer-sponsored insurance (ESI) to be more complicated than ever in 2023 as the unwinding of the continuous coverage requirement begins. Roughly 18 million people are expected to lose Medicaid coverage of which 9.5 million are expected to enroll in ESI. Much of the focus of Medicaid unwinding planning in states and the federal government has been on helping eligible people keep Medicaid coverage and steering the millions of people losing Medicaid eligibility toward the health insurance marketplace. Less attention has been devoted to the millions of people who are expected to be eligible for ESI when their Medicaid coverage ends. This issue brief discusses how state Medicaid agencies, state-based marketplaces, labor departments, and employers can play critical roles in helping people understand and navigate their coverage options.

A companion issue brief, Unwinding the Medicaid Continuous Coverage Requirement—Transitioning to Employer-Sponsored Coverage discusses the proportion of individuals with an offer of employer-sponsored coverage by income and state, and the proportion of those offers that are considered affordable based on premium cost.

To support communications efforts during the unwinding, SHVS has also produced sample messaging for state departments of labor to share with the employer community which explains the unwinding and coverage options for employees.


Expert Perspectives

October 4, 2023

How Medicaid Agencies Can Leverage Multi-Payer Aligned Measure Sets

This expert perspective reviews how Medicaid programs in Connecticut, Massachusetts and Rhode Island have engaged with commercial payers, providers, patients, advocates and other parties to create and adhere to multi-payer aligned measure sets. It describes the benefits to Medicaid agencies of participating in aligned measure set efforts, as well as tips and resources for Medicaid agencies intersted in measure alignment.

September 26, 2023

CMS Finalizes Medicaid Rule to Streamline Enrollment into Medicare Savings Programs

This expert perspective provides a high-level overview of key provisions included in the “Streamlining Medicaid; Medicare Savings Program Eligibility Determination and Enrollment” final rule that will facilitate enrollment and retention of Medicare Savings Program (MSP) coverage. MSPs are state-run programs that help low-income Medicare enrollees pay their Medicare premiums and/or cost-sharing. While the final rule’s effective date is November 17, 2023, CMS delayed compliance dates for most provisions until April 1, 2026, to reflect states’ competing priorities in light of the “unwinding” of the Medicaid continuous coverage requirement.