Approximately 12.5 million people are dual eligible: enrolled in both Medicaid and Medicare. Some of these dual-eligible beneficiaries are at risk of losing their Medicaid coverage, meaning they will no longer qualify for their D-SNP plan. If you have D-SNP clients, you may lose them to another Medicare agent. You need to be proactive – reaching out to educate them and guiding them through the changes. Contacting these clients now could prevent them from experiencing a gap in coverage.

Recent Impacts to Medicaid Eligibility

When the federal government declared the COVID-19 Public Health Emergency (PHE), it passed a law that required states to provide “continuous coverage” to Medicaid beneficiaries. This meant no one was disenrolled during the PHE, even if they no longer qualified. New federal law ended this continuous coverage on March 31, 2023. Medicaid beneficiaries are now required to renew their benefits to prove they are still eligible. Anyone who loses their Medicaid eligibility will no longer qualify for a D-SNP plan.

Your D-SNP Clients Need Your Guidance

You play a vital role in educating your D-SNP clients on what is happening with Medicaid enrollment and what steps they should be taking to renew their eligibility. Texas Health and Human Services recommends everyone create an online account and make sure contact information is up to date, including addresses, telephone numbers, and any changes to the number of people in the household. Users can set up accounts to receive text messages or email alerts with important communications.

All D-SNP enrollees must renew their coverage to prove their eligibility. Some will need to submit a new application. Let your clients know they need to stay alert for notices from the Texas HHS, which will come in a yellow envelope with the words “Action Required” in red. They should respond to any request for information as soon as possible to avoid a potential lapse in insurance coverage.

If any of your clients who are disenrolled from Medicaid disagree with the decision, they can file an appeal by sending a letter to Texas Health and Human Services Commission, P.O. Box 149027, Austin, TX 78714-9027, by calling 2-1-1 and choosing Option 2 after selecting a language, or by visiting a local office.

You can also refer your clients to the Texas HHS FAQ to help answer any additional questions they have.

When Medicaid Eligibility Changes

If any of your clients become ineligible and are disenrolled from Medicaid, they will no longer qualify for a D-SNP and will need to select another Medicare Advantage plan. You can help them find a new plan that fits their current needs.

Medicaid beneficiaries who lost coverage on or after January 1, 2023, will qualify for a Special Enrollment Period. During this SEP they can:

  • Change from their current Medicare Advantage Plan or Medicare Prescription Drug Plan to another
  • Drop their Medicare Advantage Plan and return to Original Medicare

The SEP starts the day enrollees are notified their coverage is ending and lasts until 6 months after their Medicaid coverage ends. Coverage begins the month after they sign up or the date their Medicaid coverage ends – whichever they choose.

Even though your clients are now ineligible for Medicaid, they may qualify for other programs that can help with out-of-pocket costs, such as Extra Help and the Texas State Pharmaceutical Assistance Program. Individuals who do not qualify for Medicaid may be eligible for the Specified Low-Income Medicare Beneficiary Program (SLMB) or Qualifying Individual Program (QI) – two of the Medicare Savings Programs.

This is likely to be a confusing time for your D-SNP clients. Since they rely on your knowledge and expertise, they will appreciate any guidance you can provide. Reassurance that you are here to help them through this time of change will strengthen your relationship and make your clients less likely to speak with other agents who may approach them.

PTT Financial is here to answer your questions. We are dedicated to helping you.