As part of the federal response to the COVID-19 pandemic, under the COVID-19 Public Health Emergency (“PHE”) and the Families First Coronavirus Response Act (“FFCRA”), NJ FamilyCare (also referred to as Medicaid) has satisfied a continuous enrollment condition for most Medicaid beneficiaries who were enrolled in the program as of or after March 18, 2020. The continuous enrollment condition will end on March 31, 2023. NJ FamilyCare will have up to 12 months to initiate, and 14 months to complete, a renewal for all individuals enrolled, which is commonly referred to as “unwinding.” The period between March 31, 2023 and July 31, 2024 is referred to as the “unwinding period.” After the continuous enrollment condition ends on March 31, 2023 and the unwinding period begins, many beneficiaries may lose Medicaid or CHIP (“Children’s Health Insurance Program”) coverage and may need to transition to other coverage, such as Get Covered New Jersey, the State’s Official Health Insurance Marketplace.

Consistent with federal guidance, the Department has advised carriers and health plans of a Special Enrollment Period (“SEP”) for qualified individuals and their families who lose Medicaid or CHIP coverage. Typically, the loss of minimum essential coverage is a qualifying life event triggering an SEP for 60 days from the date of the event. Due to the importance of maintaining coverage during this critical time, the Department is extending this period to 120 days for those who lose Medicaid or CHIP coverage during this unwinding period. This SEP, hereinafter referred to as the “Unwinding SEP,” will allow individuals who have lost NJ FamilyCare coverage to apply for coverage through Get Covered New Jersey or directly through carriers for a 120-day period from the date their coverage ended.

The Department has updated “Get Covered New Jersey”, New Jersey’s state administered health insurance exchange, to permit eligible consumers who submit a new application or update an existing applicant’s eligibility to enroll for 120 days from the date of the loss of coverage. In the case of accounts automatically transferred from NJ FamilyCare, Get Covered New Jersey will automatically provide the 120-day window for individuals to enroll in a Qualified Health Plan (“QHP”), with the option to retroactively align the QHP start date to the end of coverage if enrolled within 60 days. For consumers who do not seek coverage from “Get Covered New Jersey” through the automatic account transfer, they will need to select from “Loss of NJ FamilyCare” during the enrollment process to access the Unwinding SEP. No additional information or documentation is required to be eligible for the Unwinding SEP. The Department is making all operational and programmatic changes that are necessary to make the Unwinding SEP available and is directing carriers in the individual market to do the same. Please see the Department Bulletin linked here for further information. 

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