HOT TOPICS
2024 Federal updates regarding Medicaid/Healthy Montana Kids (HMK) Eligibility, Enrollment & Renewal
- November 30, 2024: Marketplace plan special enrollment period to access coverage on the Marketplace ends November 30, 2024 for those who are over income eligibility for Medicaid or Healthy Montana Kids. Healthcare.gov
- March 28, 2024: The Centers for Medicare & Medicaid Services (CMS) released the Streamlining Medicaid, Children’s Health Insurance Program, and Basic Health Program Application, Eligibility Determination, Enrollment, and Renewal Processes (CMS-2421-F2) final rule. (CMS Fact Sheet)
Summary: The Centers for Medicare & Medicaid Services (CMS) announced plans to extend the end date of the “unwinding Special Enrollment Period” (SEP) from July 31 to November 30, 2024 in states that use HealthCare.gov. In January 2023, CMS created that SEP for anyone losing Medicaid or Children’s Health Insurance Program (CHIP) coverage between March 31, 2023 and July 31, 2024 to help them avoid gaps in health coverage during unwinding. The extension will allow people losing Medicaid/CHIP, especially people in states that are taking longer than expected to complete the unwinding process, to make a smoother transition to marketplace coverage. The new November 30 deadline overlaps with the November 1 start of marketplace open enrollment, which could help eliminate a gap in coverage for people who have lost their Medicaid coverage and are seeking marketplace coverage to start before January 1, 2025.
The unwinding SEP is now available to anyone who lost or will lose Medicaid or CHIP coverage at any time between March 31, 2023 and November 30, 2024. People can access the SEP by submitting (or updating) an application on HealthCare.gov and answering “yes” to the question whether their Medicaid/CHIP recently ended or will soon end and attesting that their coverage ended/will end between March 31, 2023 and November 30, 2024. People then have 60 days after being determined eligible for the marketplace to select a plan and pay their first month’s premium. States that operate their own marketplaces control their own SEP policies and can adopt similar extensions.
No Surprises Act (NSA)
What is the NSA?
When it comes to surprise medical bills, it’s the No Surprises Act, originally passed during the Donald Trump Administration, and took effect on January 1, 2022.
The No Surprises Act (NSA) went into effect protecting individuals with private health insurance from surprise medical bills. In other words, if you are insured by a company that is not Medicare or Medicaid and receive emergency medical care or a scheduled procedure at an in-network facility then, in most circumstances, you will not be billed at “out of network” rates. This law, signed by President Trump in 2020 and now being implemented under President Biden, goes a long way in protecting consumers from what the industry calls “balance billing.”
“The No Surprises Act is likely one of the most significant bi-partisan laws protecting American healthcare consumers in more than a decade.” Commissioner Troy Downing said, “This law helps protect the consumer from getting caught in the crossfire between health care providers and insurance companies and gives them important protections that can often shield them from financial ruin or bankruptcy from surprise medical bills.”