Annual Medicaid Eligibility Review Will Create Special Enrollment Period for Marketplace-Eligible Consumers
The Eligibility Review Process Runs From April 2023 Through March 2024
The Centers for Medicare & Medicaid Services (CMS) announced a Marketplace special enrollment period (SEP) for qualified individuals and families who lose Medicaid coverage when the terms of the COVID-19 related Public Health Emergency (PHE) expire on May 11, 2023. Annual eligibility reviews, which were paused during the PHE, will resume April 1, 2023.
The SEP begins March 31, 2023, and ends July 31, 2024.
Determining SEP Eligibility
To determine eligibility for the SEP, consumers must first complete a two-step process.
STEP ONE
On a new or existing application, answer “yes”, Medicaid or Children's Health Insurance Program (CHIP) coverage has recently ended or will end soon. Applications can be submitted beginning March 31. The deadline for submission is July 31, 2024.
STEP TWO
Confirm that a Medicare or CHIP coverage loss has occurred between March 31, 2023, and July 31, 2024.
South Carolina's Department of Health and Human Services plans to mail the first round of redetermination notices and review forms to Medicaid members in April. The agency anticipates it will take 12 months to complete this process.
SCDHHS Eligibility Review Process Timeline
February:
Each month:
To market coverage solutions to new prospective members during the SEP, we've created materials to help you attract that business. You'll find these materials on Storefront under Individual & Family > Marketing Materials 2023:
*Spanish versions are also available.
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