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

CMS Releases Information Bulletin on Coverage of Services and Supports to Address Health-Related Social Needs in Medicaid

This expert perspective summarizes CMS’ new Informational Bulletin and accompanying framework which together detail Medicaid coverage options for services that address the health-related social needs (HRSN) of Medicaid enrollees. The new guidance reiterates the importance of addressing HRSNs to improve access to care and health outcomes, and summarizes (and in some cases updates) multiple previous sources of CMS guidance on how HRSN services may be covered in Medicaid, including guidance on in lieu of services authority and on HRSN coverage in section 1115 waivers.

State-Based Marketplace Transition Data During the Unwinding

Given the potential to reduce coverage losses during the unwinding, there is intense interest in data that monitors transitions between Medicaid and Marketplace coverage. State-Based Marketplaces (SBMs) that operate their own eligibility platform should consider releasing available data on Marketplace transition outcomes. This expert perspective includes an interactive map with links to SBMs reporting Marketplace transitions, a table of the indicators that states are reporting on, and select data highlights. The expert perspective also highlights recommendations for SBMs when presenting unwinding data, such as providing context and making the data easy to use. SHVS will continue to update this EP as more SBMs publish unwinding data.