2024 Pay or Play Affordability Percentage

Expected Increase in HIPAA Special Enrollment Requests

On April 1, 2023, states that maintained continuous Medicaid enrollment during the COVID-19 pandemic could start terminating coverage for ineligible individuals. While some of these individuals will enroll in subsidized coverage through the Exchange, federal regulators expect around 5 million people will seek employer-sponsored health coverage. Therefore, employers can expect an increase in midyear enrollment requests from those losing Medicaid coverage.

HIPAA Special Enrollment

The Health Insurance Portability and Accountability Act (HIPAA) requires group health plans to offer special enrollment opportunities beyond the typical enrollment period. This includes when employees and their dependents lose eligibility for Medicaid or a state Children’s Health Insurance Program (CHIP).

The Centers for Medicare and Medicaid have provided states with up to 12 months following the end of continuous enrollment to initiate renewals for those currently enrolled in Medicaid, and this process is referred to as “unwinding.” Through gradual unwinding, not all ineligible individuals will lose Medicaid coverage on April 1, 2023. Depending on each state’s unwinding timeline, coverage will be lost over the span of one year.

It is important to note that employees who lose Medicaid or Chip coverage have at least 60 days to request special enrollment. However, the deadline for requesting special enrollment for group health plans has been extended during the COVID-19 pandemic. This extension comes from the “outbreak period,” which is expected to end July 10, 2023, thus reverting back to the 60-day deadline.

Employer Next Steps

Employers must allow employees and their dependents who have lost Medicaid coverage to enroll in their group health coverage as special enrollees as long as they are eligible under the terms of the plan and request enrollment within the appropriate amount of time.


If you have any questions about the HIPAA special enrollment period, please contact your dedicated Creative Benefits, Inc. team member.