The Centers for Medicare and Medicaid Services (CMS) released the final Notice of Benefit and Payment Parameters (NBPP) on April 17, 2023. The final rule provides State-Based Exchanges (SBEs) autonomy to decide whether to implement various changes to special enrollment periods (SEPs). These flexibilities allow SBEs to better adjust existing policies and processes during the Public Health Emergency (PHE) unwinding. The changes are as follows:
- Previously, to be eligible for an SEP, everyone in a household must independently qualify for the SEP. However, under the final rule, now only one household individual needs to qualify and the entire household can make plan changes. This allows a family to make plan changes that fit the needs of the entire family.
- The SEPs have also been changed to allow individuals who will lose their health insurance coverage (MEC) in the middle of a month to apply for coverage earlier than before. The current regulations provide coverage from the first day of the month following the plan selection but do not allow overlapping coverage for people whose coverage ends in the middle of a month. This can lead to gaps in coverage that were not intended.
- In addition, CMS will allow eligibility for subsidies for consumers who may be in a situation where their MEC ends mid-month, which will provide a more seamless transition of coverage for consumers. CMS allows Exchanges to make their own decisions regarding coverage start dates.
- The final rule also allows for expanded 90-day SEPs to accommodate individuals churning off Medicaid and/or CHIP (Children’s Health Insurance Program) during the PHE unwinding. Currently, all SEP shopping windows are 60-days from the life event date. The expanded window allows states to conduct outreach to individuals losing coverage to better ensure they are aware of coverage options though the Exchanges.
These new changes continue to build upon the flexibility and autonomy afforded to state-based exchanges. States are in the best position to decide how to keep their residents insured and can build programs tailored to their specific needs — including how and when to offer SEPs.