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Transitioning from Medicaid to Marketplace Coverage

It is estimated that as many as 18 million people may lose access to Medicaid coverage over the next year as a result of the unwinding process. Approximately 3 million Americans who are no longer eligible for Medicaid coverage will have access to subsidized Marketplace coverage. The Affordable Care Act’s Health Insurance Marketplaces (also known as the “Marketplaces” or “exchanges”) provide health care coverage options for individuals and families who do not have access to coverage through their employer and are ineligible for Medicaid and Medicare. The Marketplaces offer high-quality, affordable coverage choices for more than 16.3 million Americans - approximately 90% of whom receive premium subsidies to help them lower their healthcare costs.
Resource
Description
Date
​CMS Medicaid Continuous Enrollment Condition Unwinding Marketplace Frequently Asked Questions (FAQ)
​The FAQs outline new changes and policy flexibilities that Federally-Facilitated Marketplaces are taking to prepare for Medicaid unwinding, including:
  • Updating account transfer-related notices
  • Modifying the Marketplace application
  • Implementing flexibilities related to data matching issues (DMI) or inconsistencies
May 16, 2023
​​AHIP Resource: Moving from Medicaid to Marketplace Coverage (Click here for the English version, and here for the Spanish version).​
This resource is designed to help people understand how to move to Marketplace coverage and the key differences between Medicaid and Marketplace coverage.​​
​​May 15, 2023
National Academy for State Health Policy (NASHP) Role of State-Based Marketplaces in Medicaid Unwinding
​State-based marketplaces (SBMs) have been actively partnering with Medicaid agencies to ensure individuals are informed and can have smooth transitions to other coverage if they no longer qualify for Medicaid. States that operate their own health insurance marketplaces or those that do so in partnership with the federal government, which is currently 21 states, are implementing a range of strategies and initiatives to help prevent unnecessary coverage losses during the Medicaid unwinding period. This brief from NASHP provides examples of some of those strategies. ​​​
​​April 24, 2023
​​​CMS Presentation: Helping Consumers No Longer Eligible for Medicaid: What Marketplace Agents and Brokers Need to Know (Transcript available here).
​This presentation includes key information for agents and brokers on Medicaid redeterminations, the Unwinding SEP, and how to prepare to assist consumers who will be transitioning coverage during the unwinding period. ​​
​​April 6, 2023
​​​Temporary Special Enrollment Period (SEP) for Consumers Losing Medicaid or the Children’s Health Insurance Program (CHIP) Coverage Due to Unwinding of the Medicaid Continuous Enrollment Condition– Frequently Asked Questions (FAQ)
​​​​This guidance outlines the Special Enrollment Period for Marketplace-eligible consumers who have been affected by Medicaid redeterminations from March 31, 2023 – July 31, 2024.
​​January 27, 2023
CMS Presentation: Strategies for SBMs to Improve Medicaid to Marketplace Coordination and Maximize Enrollee Transitions at the End of the Continuous Enrollment
These slides provide a “punchlist” of policy and operational strategies that SBMs and the FFM are utilizing to improve Medicaid to Marketplace coordination and maximize enrollee transitions and coverage retention.  ​
February 2, 2023
​CMS Presentation: Strategic Approaches to Engaging Managed Care Plans to Maximize Continuity of Coverage as States Resume Normal Eligibility and Enrollment Operations
​This presentation provides scenarios of ways health plans can engage with states and beneficiaries to support continuity of coverage during unwinding.
January 2023
CMS Communications Toolkit: Medicaid and CHIP Eligibility Renewals
​This toolkit provides ​key communications about Medicaid unwinding for stakeholders and consumers.
2023
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  • Home
  • Resources
    • Partner Resources
    • Fraud Prevention
    • Unwinding Guidance
    • Engagement Strategy
    • TCPA
    • ACA Coverage
    • Employer Coverage
  • Newsroom
    • Unwinding News Tracker
  • CCC Briefing