Special Enrollment Period (SEP) - Losing Medicaid Coverage

Yes, qualified individuals and their families who lose Medicaid or All Kids coverage due to the end of the continuous enrollment condition, also known as “unwinding,” may be eligible for an ACA Marketplace Special Enrollment Period (SEP). 

Between March 31, 2023 and July 31, 2024, ACA Marketplace-eligible consumers who lose their Medicaid or All Kids coverage due to the end of continuous coverage can access the SEP by submitting or updating an application through HealthCare.gov, a certified partner that supports SEPs, or the ACA Marketplace Call Center. If you are determined eligible for this SEP you will have 60 days from the date on which you submit a new or updated HealthCare.gov application to make a plan selection.

Note: After July 31, 2024, if you were unable to enroll in ACA Marketplace coverage because you did not receive a timely notice of termination of Medicaid or All Kids coverage, you may contact the ACA Marketplace Call Center at 1-800-318-2596 (TTY: 1-855-889-4325) to request an SEP, which will be granted on a case-by-case basis. Finally, you do not have to wait for your Medicaid or CHIP coverage to end, before submitting an application for ACA Marketplace coverage. Per regulation, if you are losing minimum essential coverage (MEC), such as Medicaid or All Kids, you may report that loss of coverage up to 60 days before your last day of Medicaid or All Kids coverage. If you lose minimum essential coverage, including most types of Medicaid and All Kids coverage, you are generally eligible for an SEP for 60 days after the date of loss of coverage. 

Your ACA Marketplace coverage will start the first day of the month following plan selection under this SEP. For example, if you are eligible for the SEP and select a plan on August 20, 2023, ACA Marketplace coverage will start on September 1, 2023. 

No. However, there are updates to the existing application question on HealthCare.gov that asks about a recent loss of Medicaid or All Kids coverage to grant the SEP to eligible consumers. You can also be determined eligible for the SEP through existing questions on partner applications that ask about a recent loss of Medicaid or all Kids coverage. 

The SEP will be available if you meet one of the following:
 

1) If you submit a new application or update an existing application between March 31, 2023 and July 31, 2024 and answer “Yes” to the application question asking if your Medicaid or All Kids coverage ended recently or will end soon, and
 

2) Attest to a last date of Medicaid or All Kids coverage between March 31, 2023 and July 31, 2024. In order to help avoid gaps in coverage during unwinding, if you receive notice from Medicaid or All Kids that you are no longer eligible for Medicaid or CHIP coverage, submit a new application or update your existing application on HealthCare.gov as soon as possible. This recommendation also applies to people whose Medicaid or All Kids coverage was terminated due to procedural reasons, so that the ACA Marketplace can evaluate their eligibility for Medicaid, All Kids, or qualified health plan (QHP) coverage with advance payments of the premium tax credit (APTC) or cost-sharing reductions (CSR), as applicable.

No, unlike other SEPs, you will not be required to submit documentation of a qualifying life event to be eligible for the SEP related to the unwinding/ end of continuous coverage. However, you will be required to attest to a loss of Medicaid or CHIP coverage as part of the application.

You should contact the Illinois Department of Healthcare and Family Services (HFS) for questions or instructions about logging into your account at abe.illinois.gov or call 1-800-843-6154. You should make sure HFS has your up-to-date contact information, to ensure you are receiving all communications regarding the status of your enrollment.