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This year’s National Academy of State Health Policy (NASHP) conference ran from September 21 – 22, 2021. At the conference, state Marketplace officials discussed their plans to address enrollee transitions when the Public Health Emergency (PHE) ends. When this occurs, millions of Americans will leave Medicaid coverage and need to be assessed for coverage through the health insurance Marketplace.

It is expected that the PHE will end in January or February of 2022. At that time, states will resume the process of redetermining Medicaid eligibility after having been barred from making any enrollee redeterminations since early 2020. Note that the PHE could be extended beyond those timeframes; if that happens, Congress might step in and allow Medicaid redeterminations to commence before the conclusion of the PHE. The changing time estimates and growing number of individuals who will need to be reevaluated for Medicaid coverage, State Based Marketplaces are taking a proactive approach in efforts to mitigate the situation.

The NASHP conference featured experts and various state representatives to share their experience and key considerations to have when preparing for Medicaid redeterminations and member transitions to the ACA Marketplace.

Foster Collaboration between State Medicaid Agencies and the Exchange

Partnerships between State Based Marketplaces (SBMs) and each state’s Health and Human Services (HHS) department or Medicaid agency may soon allow those SBMs to “funnel” people whose Medicaid coverage ends into more appropriate coverage. Due to the American Rescue Plan (ARP), which increased the subsidies for marketplace enrollees, low- or no-cost health plans will be available to a portion of the millions of Medicaid enrollees who will lose their current coverage after the PHE.

Here are some examples of how SBMs are working to address shifts between Medicaid and marketplace eligibility:

  • In Maine, the soon-to-be-launched SBM is a sister operating division of the Medicaid eligibility department – allowing transitions of coverage to be addressed.
  • In Maryland, the SBM is fully integrated with the state’s Medicaid eligibility system, allowing for seamless transitions between Medicaid and the marketplace.
  • In Washington, a team of eligibility workers help to ensure Medicaid enrollees who report changes will be moved into an affordable marketplace plan.

Take a Proactive Approach to Member Communication

Anticipating the upcoming transition away from Medicaid coverage for many, SBMs are also working to communicate proactively with members through outreach and engagement. Taking the proper measures to inform current Medicaid recipients to gather the needed redetermination data, provide options for enrolling on the ACA Marketplace, or extending the line of communication in efforts to respond to member questions will provide a smoother transition following the end of the PHE. Several states have already acted and begun to reach out to potentially impacted members, for example:

  • Maryland is sending out advance notices to Medicaid enrollees informing them the PHE will be ending and advising about the potential impacts on health coverage.
  • Kentucky, another state in the process of transitioning to an SBM model, intends to continue aggressive outreach campaigns.
  • In Washington, SBM leaders are relying on lessons learned from administering a state-funded premium assistance program, which taught state officials a lot about complicated outreach.

SBMs Prepare for Staffing Increases

The Washington HealthPlanfinder marketplace plans to maintain staffing increases from open enrollment (OE) after OE ends, in preparation for the influx of marketplace enrollees who are losing Medicaid coverage as the PHE terminates. Other states will probably consider a similar strategy to prevent staff from becoming overwhelmed by the dramatic increase in enrollees.

As a health insurer, the eventual end of the PHE is inevitable. And the best way to prepare is to understand your market, including your operating states’ initiatives and deadlines. And when you’re ready to leverage integrated cloud solutions that provide eligibility, enrollment, billing, reporting, and communications solutions, contact Softheon.

Meet the Author


Josh Schultz is a Senior Policy Analyst at Softheon, where he advises the company on health policy issues affecting businesses and government health agencies. Prior to Softheon, Josh worked for a non-profit agency assisting Medicare beneficiaries, a technology company, and consulting firms.