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  • David Lamar

Redetermination "Unwinding"

Medicaid provides healthcare coverage to millions of low-income Americans, but for some, the coverage may end due to changes in eligibility requirements. The Centers for Medicare & Medicaid Services (CMS) has now introduced a new way to help those who lose their Medicaid or CHIP coverage, called the Unwinding Special Enrollment Period (SEP).

This new SEP allows individuals and families in Marketplaces served by to enroll in a Marketplace plan outside of the annual Open Enrollment period. Normally, individuals who lose Medicaid or CHIP coverage would have to wait until the next Open Enrollment period to enroll in a Marketplace plan. However, with the Unwinding SEP, they now have more time to enroll in a plan that fits their needs.

The Unwinding SEP applies to qualified individuals and their families who lose Medicaid or CHIP coverage due to the end of the continuous enrollment condition, also known as “unwinding.” To be eligible for the Unwinding SEP, Marketplace-eligible consumers must submit a new application or update an existing application between March 31, 2023 and July 31, 2024, and attest to a last date of Medicaid or CHIP coverage within the same time period.

Consumers who are eligible for the Unwinding SEP will have 60 days after they submit their application to select a Marketplace plan with coverage that starts the first day of the month after they select a plan. For example, if a member loses Medicaid eligibility in May 2023, they could apply for Marketplace coverage in April 2024 and attest to losing coverage in May 2023. Their 60-day period to choose a plan would start in April 2024, on the date they applied for Marketplace coverage.

The introduction of the Unwinding SEP is good news for individuals and families who may have lost Medicaid or CHIP coverage due to changes in eligibility requirements. It provides them with a valuable opportunity to enroll in a Marketplace plan that will meet their healthcare needs.

If you have questions about Marketplace eligibility and the Unwinding SEP, call The Lamar Agency at 855.545.2627. We can help you understand your options and guide you through the enrollment process.


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