On January 27, 2023, the Centers for Medicare & Medicaid Services released a State Health Official (SHO) letter, “Medicaid Continuous Enrollment Condition Changes, Conditions for Receiving the FFCRA Temporary FMAP Increase, Reporting Requirements, and Enforcement Provisions in the Consolidated Appropriations Act, 2023.” The SHO letter is the second in a series of guidance related to section 5131 of the Consolidated Appropriations Act, 2023 (CAA), which established a fixed end date for the Medicaid continuous coverage requirement, a gradual phase-down for the enhanced federal match, and new guardrails for mitigating coverage loss for individuals who continue to be eligible. This expert perspective reviews the additional detail and operational expectations of states during the unwinding of Medicaid continuous coverage as laid out in the SHO letter.
SHOP Notices and Appeals Webinar
Sharon Woda, Manatt Health Solutions Adam Block, Manatt Health Solutions Lisa Sbrana, New York Health Benefit Exchange Kelly Smith, New York Health Benefit Exchange
The State Coverage Initiatives program, in coordination with the State Network, hosted a webinar Tuesday, July 23 from 1:30 – 3:00 p.m. EDT to discuss Small Business Health Option Programs (SHOP) notices and appeals. Sharon Woda and Adam Block from Manatt Health Solutions, and Lisa Sbrana and Kelly Smith from the New York Health Benefit Exchange (NYHBE) facilitated this event. The webinar covered various issues, including:
– Federal requirements for SHOP notices;
– Notices that will be used by the NYHBE to communicate with employers and employees served by the SHOP (found here); and
-Discussion of the proposed SHOP appeals regulations and corresponding policy and operational decisions made by the NYHBE in developing their SHOP appeals process.
The webinar slides can be found in the blue “Download” icon and the NYHBE SHOP Notice template can be found here.