CMS to Launch Pilot Program on Marketplace Special Enrollment Eligibility Verification
Pilot to Begin in June 2017
As part of its continuing effort to ensure that Health Insurance Marketplace special enrollment periods are only available to those who are eligible for them, the Centers for Medicare & Medicaid Services (CMS) has announced a pilot program starting in 2017 that will test the impact of pre-enrollment verification on compliance, enrollment, continuity of coverage, and other outcomes.
Pilot Program Details
CMS will pilot the pre-enrollment verification in both the federally-facilitated and state-based Marketplaces that rely on the Healthcare.gov platform. All special enrollment period types will be subject to enhanced verification in some form, whether through the pilot or through other enhanced procedures. In particular, applications based on loss of minimum essential coverage will be included in the pilot.
Applications will be randomly selected for the pilot, with 50% of new applications with relevant special enrollment periods taking part. Consumers included in the pilot will still be able to submit their application and select a plan, with a coverage effective date determined by the date of plan selection. However, the Marketplace will “pend” the consumer’s enrollment until the consumer submits documents that establish his or her eligibility for a special enrollment period.
Pilot Program Start Date
The pilot will begin in June 2017 and CMS anticipates basing future decisions about special enrollment period verification procedures on the results of the pilot. Before the pilot begins, CMS will offer extensive training so that agents, brokers, and others are able to help consumers find and submit the necessary documents.
Click here for more information on the pilot program.
