The COVID-19 federal Public Health Emergency (PHE) allowed beneficiaries to continue receiving health care coverage under special eligibility rules. The PHE rules helped prevent people with Medicaid from losing their health coverage during the pandemic.
The federal PHE is scheduled to end later this year. While we do not know for certain when the PHE will end, NC Medicaid wants to help beneficiaries and Local DSS understand any potential impacts and steps they can take to be ready.
End of the PHE: NC Medicaid Redetermination Approach
- In North Carolina, Local DSS continue to conduct eligibility redeterminations for beneficiaries during the PHE. However, per federal guidance, a few beneficiaries with specific situations have had their coverage terminated or reduced during the PHE.
- When the federal PHE ends, Local DSS will initiate redeterminations over the next 12 months as they are due. Redeterminations that are completed the month after the PHE ends may result in termination or reduction of NC Medicaid benefits. The eligibility requirements for NC Medicaid have not changed. Per guidance from the Centers of Medicaid and Medicare (CMS), redeterminations will be initiated within 12 months and completed within the next 14 months.
- NC Medicaid coverage will end for approximately 37,000 beneficiaries within the COVID-19 Vaccination, Testing and Treatment temporary eligibility population. NC FAST will terminate benefits for this population. This population is excluded from NC Medicaid Managed Care and will receive a Medicaid Eligibility termination notice prior to the end of the PHE.
- NC Medicaid applications will continue to be processed timely by the Local DSS.
- If a beneficiary is determined to no longer qualify for Medicaid services, they will receive:
- Notice of when their Medicaid coverage will end or change.
- Information on how to request an appeal.
- Information about the Health Insurance Marketplace and other affordable health care coverage options (healthcare.gov).
Coming Soon: End of Public Health Emergency Local DSS Reference Guide
In preparation for the PHE ending, NC Medicaid will be publishing an End of PHE Local DSS Reference Guide. More information will be provided soon.