State-Based Marketplaces Are Play a Significant Role in Medicaid Unwinding

Nationwide, state-based marketplaces have been partnering with Medicaid agencies to prevent gaps in coverage if consumers no longer qualify for Medicaid. Developing effective communication strategies is key for Medicaid recipients, health center patients, and other vulnerable communities. The PA Department of Human Services (DHS) has worked with Pennie, Pennsylvania’s state-based marketplace, to ensure messaging and outreach strategies align during the Medicaid continuous coverage unwinding period which began April 1. This includes co-branded mailers for those not replying to their renewal packet. Pennie also meets with DHS on a weekly basis to share data, coordinate press tours and update partner toolkits. Other states have created a year-round Special Enrollment Period for individuals with income up to 250% of the Federal Poverty Level. Covered California has implemented a program that automatically enrolls individuals in a marketplace plan when they lose Medicaid coverage, while Pennie has an automated eligibility system that provides individuals losing Medicaid who are account-transferred with an eligibility determination and automatic special enrollment period. However, consumers must claim their account and select a plan to enroll. Since April 1, Pennie’s key focus has been operational activities associated with the unwinding. Thousands of applications have been received for consumers who exceed the income qualifications for Medicaid. Individuals in the initial unwinding group with Medicaid coverage ending at the end of April are now in their 60-day window where they can select a plan and have continuous coverage through retroactive coverage dates to May 1, 2023. The Pennie Community Workgroup meets the second Friday of each month to provide updates, enrollment activity, processes, and procedures specific to the transition of consumers from Medicaid to marketplace coverage.

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