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Employee Benefits

What Does the End of the Public Health Emergency Mean for Your Employee Benefits Plan?

Claire Pancerz
Claire Pancerz
Compliance Director, Employee Benefits

Update 4/10/2023 — Since this blog initially ran, the Department of the Treasury, the Department of Labor, and the Department of Health and Human Services (the “Departments”) have released FAQ guidance clarifying the approach to the end of the COVID-19 induced Public Health Emergency and the National Emergency. We have summarized all new details in a new blog. Please click here to read that blog.

Well, folks…the pandemic’s over. The federal government has announced its intention to end the Public Health Emergency (PHE) and the National Emergency (NE) as of May 11, 2023. While this is good news in that it signals a further return to the “before times,” there are some issues for employee benefit plan sponsors to confront.

Changes to Qualifying Life Event Timeframes

As a reminder, the “Outbreak Period” is the time 60 days after the end of the PHE. After this time has been reached, we return to standard Employee Retirement Income Security Act (ERISA) timeframes for things like sending COBRA notices, enrolling in COBRA, paying for COBRA, filing or perfecting appeals, and requesting or perfecting a request for an external review.

Additionally, employees will once again have to adhere to a plan’s notification requirements for qualifying life events or HIPAA special enrollment. Your company’s health plan(s) may specify a 30- or 31-day time to notify the plan of a special enrollment or other change; federal requirements are for a 60-day period of time when dealing with a loss of Medicare or Medicaid coverage.

At this point, we’re fairly used to being able to add a spouse or a child with exceptionally late notice. We also know that employees can seem to struggle with remembering this requirement. Remember that whether — and how long — an employee may have to deliver this notice is going to depend specifically on the date of the event itself.

Federal regulations extended timeframes to add individuals to a health plan for the shorter of:

  • One year from the date following the event; or
  • 60 days after the end of the PHE.

Medicaid Re-evaluation

Here’s where it gets even trickier. HR teams are also now going to be confronted with the results of the current Medicaid re-evaluation.

During the pandemic, states were given extra federal dollars to keep people on Medicaid, even if circumstances had changed and they would ordinarily have been moved off this coverage. With the end of the pandemic, each state is responsible for going through its own rosters to ensure that people with Medicaid coverage are entitled to it.

The Kaiser Family Foundation has estimated that between 5 and 14 million people will lose coverage; many of those will be looking back to their employers for health insurance — meaning you!

The re-evaluations will begin on April 1, 2023, but different states have differing timeframes for sending letters and removing individuals from Medicaid. Remember that the qualifying life event generated by a loss of Medicaid coverage means that employee has a 60-day window to make you aware of the change.

For more information on state support for any of your employees coming off the Medicaid rolls, please see Georgetown’s state resource spreadsheet. Information from CMS regarding state timeframes is also found here.

We’re Here to Help!

In short, if you thought that a return to normal meant you could relax and anticipate that open enrollment would be your busiest season — well, the pandemic may be over, but regulators still expect us to do a lot of clean up.

The good news is that we have experts who are keeping a sharp focus on legislative and regulatory changes for you, and we understand them. So, please don’t hesitate to ask your Holmes Murphy service team for more information.

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