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June 10, 2013

DOL Updates Model Medicaid/CHIP Notice

The Children’s Health Insurance Program Reauthorization Act (CHIPRA) enacted in 2009 provides for two additional HIPAA special enrollment events.  These special enrollment events relate specifically to Medicaid.  One special enrollment event arises if an individual loses eligibility for Medicaid.  The other arises when an individual becomes eligible for premium assistance through Medicaid.  “Premium assistance” means that a State’s Medicaid or Children’s Health Insurance Program (CHIP) will pay all or a portion of the employer-provided coverage.  Employers sponsoring health plans are obligated to annually provide a premium assistance notice to their workforce.  This notification can be accomplished by using a model notice provided by the Department of Labor (DOL).  

The DOL has recently released an updated model “Premium Assistance under Medicaid and the Children’s Health Insurance Program (CHIP)” notice that can be obtained from its website (the pdf version of the model notice can be accessed here; the word version of the notice is available here).  The revised notice, current as of January 31, 2013, only makes two changes from the July 2012 version:

  1. Revised Medicaid phone number in New Jersey; and
  2. Deletion of one of the two Medicaid/CHIP websites in Oregon.

As review, the current list of states that provide some form of premium assistance are:

States with Premium Assistance

Alabama

Kentucky

New Jersey

Texas

Alaska

Louisiana

New York

Utah

Arizona

Maine

North Carolina

Vermont

Colorado

Massachusetts

North Dakota

Virginia

Florida

Minnesota

Oklahoma

Washington

Georgia

Missouri

Oregon

West Virginia

Idaho

Montana

Pennsylvania

Wisconsin

Indiana

Nebraska

Rhode Island

Wyoming

Iowa

Nevada

South Carolina

 

Kansas

New Hampshire

South Dakota

 

This Medicaid/Premium Assistance Notice explaining the right to premium assistance must be provided to anyone residing in these States, without regard to where the employer is located, or where the plan is sitused.  The employer can provide the notice to all of its employees, or just to those who are residing in the above-listed states. 

 

 

The information contained in this Benefit Beat is not intended to be legal, accounting, or other professional advice, nor are these comments directed to specific situations.

As required by U.S. Treasury rules, we inform you that, unless expressly stated otherwise, any U.S. federal tax advice contained in this Benefit Beat is not intended or written to be used, and cannot be used, by any person for the purpose of avoiding any penalties that may be imposed by the Internal Revenue Service.

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