Dear Valued Agent/Broker Partners and Navigators,
Public Health Emergency (PHE) Unwinding
Starting this past April 1, the State of Nevada began what’s known as the Public Health Emergency (or PHE) Unwinding. This Unwinding has potential effects on Nevada Medicaid recipients. To set the stage, at the beginning of the Covid-19 pandemic, the federal government designated a Public Health Emergency. With this designation, Medicaid agencies across the country, including Nevada, were able to pause taking action on eligibility redeterminations for their Medicaid populations. This pause ended on Saturday, April 1, 2023. Redeterminations made by Nevada Medicaid on and after April 1 will have action taken on them, with recipients being redetermined eligible or ineligible for Medicaid coverage.
This Public Health Emergency Unwinding redetermination process will take place over the next 14 months. To aid in helping these recipients be redetermined ineligible, the Exchange’s Board passed a 16-Month PHE Unwinding SEP. Details may be found here.
Medicaid recipients with automatic account transfers from Medicaid to the Exchange due to over-income (over 138% of the federal poverty level) will be able to enroll without having to provide further documentation. Medicaid recipients that do not respond to Medicaid redetermination packets and are redetermined ineligible for being non-responsive will have to provide proof of loss of Medicaid coverage. These enrollments will be a “gated” event.
It is important for consumers to know 3 main things:
- Please be proactive in updating your information with Nevada Medicaid
- Please know or learn your Medicaid anniversary date, and pay attention to communications and/or packets sent to you by Nevada Medicaid
- Know that if you are redetermined ineligible for Nevada Medicaid, and up to possibly 200K Nevadans may be, know that Nevada Health Link is here for you as the next best option for affordable, comprehensive health insurance.
For those Medicaid recipients redetermined ineligible, Nevada Health Link may be their next best option if employer-sponsored insurance (ESI) isn’t available. At Nevada Health Link, we understand that for health care to be accessible, it has to be affordable. At Nevada Health Link, almost 9 out of 10 consumers received financial assistance in terms of reduced monthly premiums or cost sharing for provider visits. Additionally, over 11K of Nevada Health Link consumers during this past open enrollment received health insurance with $0 monthly premiums.
As more Nevadans are redetermined ineligible and come to Nevada Health Link as a health insurance solution in the next few weeks and months, please start to expect an increase in referrals, Call center hold time, ticket resolutions, and ROP Clarifications.
Call center hold times:
Due to the increase in call volumes, we have been experiencing higher-than-normal hold times. We anticipate the call volumes to continue to increase as we approach the unwinding of the Public Health Emergency. We appreciate your patience as our Call center continues to assist our Brokers and Consumers.
Ticket resolution:
We have received multiple emails regarding the timing of ticket resolution. As a result of high call volumes, we are experiencing higher ticketing volumes. All tickets received are worked by priority and then by the date received (oldest to newest). At this time, we ask that you allow 7 business days for all Critical ticket resolutions and a minimum of 21 business days for all other ticketing resolutions. Please note this timeframe does not include document verification tickets.
ROP Clarification
We recognize and understand that there may still be concerns regarding consumers with open DMIs. We want to ensure you that our goal is keeping Nevadans insured. ROP is very complex in nature, and we want to provide as much guidance as possible to make this easier for brokers and consumers.
As explained in previous meetings there has been an increase in the restrictions for those who qualify for exceptional circumstances due to the expiration of ROP. In addition to that, there is guidance in the CFR that could warrant an exception for some consumers. For example, there could be an exception for consumers that did NOT receive any notification and provide why it was not received, our QA team would then review the account for a potential exception. Another example of an exception would be that there was an attempt to upload the documentation prior to the expiration taking place, if we can see the document on file, we will grant an exception for reinstatement.
It is very important to note that when a ticket is being created for ROP reinstatement, ALL details are included in the ticket request. All potential reasons for an exception need to be included so that our team can be equipped with the information they need to make the best decision on the ticket the first time. When all details are provided on the initial submission of the ticket it will cut down the number of times a ticket is reassigned for further clarification.
The RFA for the Broker and Navigator Award Program is now available on our website.
Requests for Applications: https://www.nevadahealthlink.com/sshix/grant-opportunities/
Additional Resources
Agent/ Broker Service Line 1-800-547-8156
Monday – Friday, 9:00 a.m. – 5:00 p.m.
