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August 1, 2019

Updated Medicaid/CHIP Premium Assistance Notice

Individuals who are eligible for employer-sponsored group health coverage, but are unable to afford the premium, may be eligible to receive premium assistance from a state’s Medicaid agency or Children’s Health Insurance Program (CHIP).  Thus, 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’s Employee Benefit Security Administration (EBSA).

EBSA recently revised its model Medicaid/CHIP notice and made current as of July 31, 2019. The revised notice differs from the model notice issued in January 31, 2019, as follows:

  • With regard to program changes, Colorado resumes offering premium assistance through its Health First Colorado (Colorado’s Medicaid program) or Child Health Plan Plus (CHP+) program.  Oregon continues to offer Medicaid but no longer offers CHIP.  And, Rhode Island adds CHIP, plus provides an additional phone number for both Medicaid and CHIP offices.
  • Contact information for various Medicaid offices has changed.  Specifically, Georgia has changed the website address and phone number.  In Minnesota, the phone number for the Medicaid office changed.  And in North Carolina, Washington and Wyoming, the website address for their Medicaid offices changed.

The revised model Medicaid/CHIP notice is available for viewing and/or downloading from the DOL’s website, in both English (PDF or Word) and Spanish (PDF or Word)

Method of distributing notice. The Medicaid/CHIP premium assistance notice can be included in other plan materials, such as open enrollment materials, or a summary plan description. Alternatively, it can be provided as a separate document. If the notice is to be included with other plan material, it must be clearly delineated as a unique document. The notice can be provided in written form; or, electronically, as long the DOL’s electronic disclosure rules are followed.

Employers are welcome to modify the model notice; though, it is very important that the document provided to affected individuals clearly explains the right to premium assistance; and most importantly, provides at least minimal information about how to contact the relevant state Medicaid or CHIP office.

Who gets the notice?  The notice explaining the right to premium assistance must be provided to employees residing in the below-listed states at least once annually, without regard to where the employer is located, or where the health plan is sitused: 

States Offering Premium Assistance

Alabama

Minnesota

Pennsylvania

Alaska

Missouri

Rhode Island

Arkansas

Montana

South Carolina

Colorado

Nebraska

South Dakota

Florida

Nevada

Texas

Georgia

New Hampshire

Utah

Indiana

New Jersey

Vermont

Iowa

New York

Virginia

Kansas

North Carolina

Washington

Kentucky

North Dakota

West Virginia

Louisiana

Oklahoma

Wisconsin

Maine

Oregon

Wyoming

Massachusetts

 

 

 

 

 

 

Penalty for failure to provide notice.   Failure to notify employees of premium assistance opportunities could result in a penalty assessment of up to $117 per day, per employee (as indexed, beginning January 23, 2019).

 

The information contained in this article is provided as general guidance and may be affected by changes in law or regulation. This article is not intended to replace or substitute for accounting or other professional advice. Please consult a CBIZ professional. This information is provided as-is with no warranties of any kind. CBIZ shall not be liable for any damages whatsoever in connection with its use and assumes no obligation to inform the reader of any changes in laws or other factors that could affect the information contained herein.

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