Medicaid Unwinding: What Is It & The Opportunity for Agents

When the COVID-19 public health emergency ends, millions of Americans may lose their Medicaid benefits and health insurance.

They’ll need help navigating these changes and finding new coverage, presenting an excellent opportunity for Medicare and Affordable Care Act (ACA) marketplace agents to build relationships and business.

We’ll explain what’s happening and discuss how to help affected individuals find the proper affordable health insurance option for them.

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What Is the Medicaid Unwinding?

The Medicaid unwinding, or the conclusion of the Medicaid continuous enrollment requirement, references the potential ending of Medicaid eligibility for those who qualify for coverage under the Families First Coronavirus Response Act (FFCRA). The FFCRA’s continuous enrollment requirement allowed Medicaid beneficiaries to stay enrolled through the end of the month in which the COVID-19 public health emergency (PHE) ends in exchange for additional federal funding.

However, on December 29, 2022, the Consolidated Appropriations Act 2023 (CAA 2023) was enacted. This bill included a provision to allow states to begin the process of Medicaid eligibility redeterminations in April, regardless of the PHE status. States will be able to choose how they handle this process. Make sure to pay attention to your state’s Medicaid office to stay up to date on the most recent changes.

On December 29, 2022, the Consolidated Appropriations Act 2023 was enacted, allowing states to begin the process of Medicaid eligibility redeterminations in April, regardless of the PHE status.

Due to the need for affordable health care options amidst the COVID-19 pandemic, Medicaid enrollment has grown substantially, and the uninsured rate has dropped. Individuals who enrolled in Medicaid after the continuous enrollment requirement was established are at risk of losing their Medicaid coverage upon states’ Medicaid eligibility redeterminations. There are two groups of individuals that may be affected by these changes more than others. Below, we’ll also suggest solutions for those groups.

Who Will It Affect?

Enrollment in Medicaid grew to around 90.9 million in September 2022, which is 19.8 million more individuals enrolled than in February 2020. This increase in enrollment reflects economic concerns, Medicaid expansion, and the effects of the Medicaid continuous enrollment requirement. KFF estimates that between 5.3 to 14.2 million Americans may lose their health insurance when the continuous enrollment provision ends and Medicaid unwinding begins.

KFF estimates that between 5.3 to 14.2 million Americans may lose their health insurance when the continuous enrollment provision ends and Medicaid unwinding begins.

From our perspective, there are two main groups of individuals who may be affected by the Medicaid unwinding: Medicaid enrollees under 65 and dual-eligible Medicare beneficiaries. These do not include every individual, and we recommend always approaching your clients’ health care needs with their individual concerns in mind. It’s important to be aware of upcoming changes in order to prevent potential gaps in coverage.

Medicaid Enrollees Under Age 65

Individuals who are younger than 65 years old, currently receiving Medicaid, but no longer qualifying based on income will lose their coverage at the end of the continuous enrollment provision. This is the largest group of individuals who will be impacted by the Medicaid unwinding.

Dual-Eligible Medicare Beneficiaries

Medicare Beneficiaries who currently have dual-eligible status but no longer meet Medicaid income requirements are at risk for losing their status and health coverage. Dual-eligible Medicare beneficiaries, or beneficiaries who receive Medicare coverage but also qualify for Medicaid benefits based on their income, may be enrolled in Dual-Eligible Special Needs Plans (D-SNPs). If they are enrolled in a D-SNP and lose their dual-eligible status, they will need to obtain different health coverage.

If you’re not already selling D-SNP plans, consider adding these plans to your portfolio to reach the estimated 12 million Americans who are dual eligible. The benefits of selling these plans can allow you to diversify your portfolio, reach new clients, and generate revenue outside of the Annual Election Period (AEP).

Opportunities for Agents

Even though millions of beneficiaries may lose Medicaid coverage, there are solutions available for many to find affordable health care coverage. Medicare and ACA agents like you can educate clients on not only what’s happening, but their future options.

Marketplace Plans

Individuals under 65 years old may qualify for an ACA plan through their state or federal marketplace. To prepare for the Medicaid unwinding, we suggest that you expand your business portfolio to include under-65 health plans if you haven’t already. Marketplace plans can be affordable for those losing their Medicaid eligibility, since there are plans with low initial costs. Additionally, it’s likely that these individuals will qualify for subsidies to lessen their costs even further as more changes are implemented to provide coverage options for families.

These plans can help you to reach new clients, create a Medicare pipeline, and generate profit all year long. To start your under-65 health journey today, reach out to one of our knowledgeable sales reps to get more info on what it takes to sell these plans.

Medicare Plans

Beneficiaries who lose their dual-eligible status will no longer qualify for a D-SNP and will need to switch to another health plan to stay covered. You can check if your client has received notice that their coverage will end and help them enroll in a new Medicare plan on time. Due to loss of coverage, your client should qualify for a Special Enrollment Period (SEP.) A new SEP was introduced to coordinate with termination of Medicaid coverage under the Consolidated Appropriations Act of 2021. Check the guidelines to see if your client qualifies when it’s time.

If you’re interested in learning more about working with dual-eligible beneficiaries, check out our beginner’s guide to D-SNPs.

What This Means for the Future

Significant changes in health and wealth status may be scary for clients. We encourage you to understand the upcoming Medicaid unwinding to help your clients easily navigate these issues. Your clients rely on you for answers to the tough questions, and as long as you position yourself as the agent willing to provide support, you will be more likely to reap the benefits of your actions.

You don’t have to face this transition alone! Register with Ritter today to have access to our educational platform, Knight School, and more tools that can help you become a knowledgeable and successful agent your clients can rely on.