Unwinding of the Medicaid continuous eligibility requirements that were put in place during the COVID-19 Public Health Emergency (PHE) continues to impact Medicaid enrollees across states. Although data is still limited, early reports show a high number of terminations due to procedural issues such as failure to complete forms or submit verification documents. Many Medicaid enrollees, including older adults, are also confused by the unwinding process and their eligibility for Medicaid or transitioning to Medicare, Marketplace, or employment-based insurance. 

Here are some helpful tips and new resources from the Centers for Medicare and Medicaid Services (CMS) regarding the unwinding. 

Transitioning to Medicare

CMS previously announced a new Medicare Special Enrollment Period (SEP) for individuals who were enrolled in Medicaid during the PHE and missed their Initial Enrollment Period (IEP) for Medicare. Individuals can use the SEP to enroll in Medicare within 6 months of losing Medicaid without facing a late enrollment penalty. Because the SEP is new, Social Security Administration (SSA) employees may not be familiar with it. Advocates often find providing the relevant SSA Program Operations Manual System (POMS) cite to the SSA employee helps speed up the enrollment process: HI 00805.385 Exceptional Conditions Special Enrollment Period (SEP) for Termination of Medicaid Eligibility. 

A similar SEP also exists for the Health Insurance Marketplace for people who are not eligible for Medicare or employer-based coverage. 

Webinars on Outreach for Older Adults and Other Special Populations

CMS is beginning a weekly webinar series this Thursday August 3rd to help advocates reach out to special populations that will be impacted by Medicaid unwinding. The August 17th webinar will focus on older adults and people with disabilities. RSVP to the webinars.

Data Snapshot

This week, CMS posted the first snapshot of data submitted by states including the total number of Medicaid renewals, terminations, and pending renewals. While procedural terminations are still high, this data indicates people who are completing their first redetermination process remain eligible and have their Medicaid renewed. More specific data with additional metrics is expected soon. 

For additional CMS resources, see Unwinding and Returning to Regular Operations after COVID-19.

We Want to Hear From You

Justice in Aging is interested in hearing from advocates about how the unwinding process is impacting older adults in your state. Please email us to share information or request technical assistance.

For additional resources and tips for advocates serving people dually eligible for Medicare and Medicaid, see COVID-19 and Public Health Emergency (PHE) Unwinding Resources.