In a national process known as the “unwinding,” state and local officials in New York have begun the gargantuan task of redetermining the eligibility of more than 9 million enrollees in Medicaid, Child Health Plus, and the Essential Plan. These checks had been suspended for three years in the U.S. as part of 2020 pandemic relief measures and were restarted by the federal Consolidated Appropriations Act enacted in late 2022. To date, state officials estimate that renewals have averaged about 80% in the first four months of the process. But about 600,000 New Yorkers have been deemed ineligible for Medicaid, including more than 300,000 individuals terminated on procedural grounds, such as not responding to mail delivered to the last known address.
Many of these individuals losing Medicaid eligibility, however, have enrolled in other NY State of Health marketplace programs; for example, about 130,000 individuals have transferred to the Essential Plan. Others may be eligible for—or have already enrolled in—job-based plans. After all, during the week ending April 11, 2020, nearly 400,000 NewYorkers filed unemployment claims; now employment has generally returned to pre-pandemic levels in New York State. As employers gear up the traditional fall open enrollment period for employee health benefits, it is the perfect time to reach out to the “unwound” workers who lost public coverage but may now be eligible for coverage on the job.
This Open Enrollment Period is Different
Open enrollment periods are a common feature in most health insurance markets, designed to spread risks over the largest groups of employees by preventing healthy individuals from postponing enrollment until a serious medical problem arises. Employers typically provide workers with an annual window to enroll in or change coverage, and newly hired workers can enroll year-round as soon as they become eligible. But federal rules require employers to provide special enrollment periods for employees who experience “life events” affecting their coverage, such as marriage, births, or the loss of coverage through a spouse’s plan. A federal law enacted in 2009 went further, extending this special enrollment treatment to employees who lost public coverage for a period of not less than 60 days from their date of termination.
A Role for Employers Which Offer Health Benefits
In this context, employers clearly have an important role to play. At a minimum, they should educate employees about the unwinding in general and the potential availability of coverage, familiarize themselves with the rules, and help eligible employees complete the paperwork and enroll in a plan. The federal Centers for Medicare and Medicaid Services and the NY State of Health Marketplace have both made educational materials available to employers. Many workers will need extra help with this complex process. Evidence from the early stages of the unwinding shows large numbers of public program members have been disenrolled for procedural reasons. Many employees may be unaware they have lost coverage or will find out only when they attempt to visit their doctor or fill prescriptions; they may also not know that the 60-day clock for their special enrollment has already begun ticking. Some workers may be eligible for coverage now in the current year, while others may become eligible well after the regular open enrollment period ends, since the unwinding will continue until July 2024.
Going the Extra Mile
Given the size and complexity of the unwinding and its intersection with the normal employer open enrollment period, the Biden-Harris administration has called on employers and plans to take additional steps to help eligible workers connect with job-based coverage. Mindful that many could be shut out by the 60-day window, the administration called for employers to keep the enrollment window open until the end of the unwinding, asserting that there are no regulatory or legal barriers that would prevent group health plans from doing so (although an insurer’s consent may be necessary).
The NYSOH Marketplace added one very creative request. Eligibility for coverage through the Marketplace, which can include premium subsidies that lower costs for workers or their dependents, typically is not available to individuals with an offer of employer-sponsored coverage—unless that offer does not meet federal minimum benefit or affordability standards. As part of its extensive unwinding toolkit, NYSOH has made their affordability tool available to employers, so they can help workers obtain coverage through the marketplace if their employer plan does not meet the standards.
New York State, in partnership with local government officials, health plans, providers, schools, civic groups, and community-based enrollment experts, has undertaken a massive campaign to help New Yorkers renew their coverage or sign up for other affordable plans. A complementary effort by employers could close the circle and help the unwound access employer-based coverage for themselves and their families.
