March 21, 2023

The Centers for Medicare & Medicaid Services (CMS) announced a Marketplace special enrollment period (SEP) for qualified individuals and families who lose Medicaid coverage when the terms of the COVID-19 related Public Health Emergency (PHE) expire on May 11, 2023. Annual eligibility reviews, which were paused during the PHE, will resume April 1, 2023.

The SEP begins March 31, 2023, and ends July 31, 2024.

Determining SEP Eligibility
To determine eligibility for the SEP, consumers must first complete a two-step process.

STEP ONE
On a new or existing application, answer “yes”, Medicaid or Children's Health Insurance Program (CHIP) coverage has recently ended or will end soon. Applications can be submitted beginning March 31. The deadline for submission is July 31, 2024.

STEP TWO
Confirm that a Medicare or CHIP coverage loss has occurred between March 31, 2023, and July 31, 2024.

Once eligible, consumers have 60 days to choose a plan.

South Carolina's Department of Health and Human Services (SCDHHS) plans to mail the first round of redetermination notices and review forms to Medicaid members in April. The agency anticipates it will take 12 months to complete this process.

SCDHHS Eligibility Review Process Timeline

• February:
  • SCDHHS will send pre-review notices for members who are scheduled for redetermination in April.
  • Each month during the redetermination period, notices will be sent approximately 30 days before a member is scheduled for redetermination. 
• April 1: first reviews initiated
• First week of April: first Continuation of Benefits notices and annual review forms mailed and text messaging to members begins
• June 1: first closures for failure to return review forms
• Each month:
  • Monthly, electronic data will be used as much as possible to confirm continued eligibility.
  • Review forms will be sent approximately 60 days ahead of the redetermination date to members for whom eligibility cannot be confirmed with electronic data.
  • Members who do not return completed review forms within 30 days will receive a notice to let them know their Medicaid coverage will end if they do not return the form by the due date.

We will issue a follow-up communication if new information is shared or changes. 

Medicaid SEP Marketing Materials* on Storefront
 
To market coverage solutions to new prospective members during the SEP, we've created materials to help you attract that business. You'll find these materials on Storefront under Individual & Family > Marketing Materials 2023:

• Customizable flyer (editable PDF)
• Facebook graphics
• Email images
• 6-by-9 inch postcards

*Spanish versions are also available.