Bridging the coverage gap: connecting consumers to federal and state-based marketplaces
After a three-year pause, states are resuming the recertification of Medicaid and Children’s Health Insurance Program (CHIP) eligibility for over 91 million people nationwide. While most people will continue to be Medicaid-eligible, millions will not. Helping these individuals find and enroll in affordable health coverage is critical to ensuring they retain access to healthcare and the financial security of being insured. For many who lose Medicaid coverage and have no other source of coverage, a state-based or federal Marketplace (Marketplace) may be a viable option.
Established in 2014 under the Affordable Care Act, Marketplaces provide health insurance coverage for individuals and families with incomes that are too high to qualify for Medicaid and whose employers do not offer affordable, comprehensive coverage. Financial subsidies, in the form of federal tax credits, help eligible individuals pay for coverage.
When the COVID-19 pandemic began in 2020, Marketplaces served as a safety net for uninsured people or people who lost employer-sponsored coverage after a job loss. To make Marketplace coverage more affordable, the American Rescue Plan Act and the Inflation Reduction Act expanded eligibility for financial assistance to individuals with incomes above 400% of the federal poverty level. Financial assistance also increased for lower-income individuals who already qualified for Marketplace subsidies. As of January 15, 2023, the Centers for Medicare & Medicaid Services (CMS) reported that 16.3 million people signed up for coverage through either federal or state-based marketplaces. For the 2023 coverage year, CMS reports that 4 out of 5 people can find Marketplace coverage for $10 or less a month after tax credits. 
As Medicaid’s continuous eligibility requirements end on March 31, those no longer eligible for Medicaid will face the difficult and often confusing decision about the coverage options available. Many will weigh the hard choice of finding coverage to remain insured or risk the health and financial security of being without it.
Health policy groups caution that millions could become uninsured rather than transitioning to other coverage, including an estimated 1.5 million who would qualify for low-cost or even free coverage in a Qualified Health Plan. Many of these individuals may need to be made aware of the availability of Marketplace coverage. Others may be overwhelmed by the application process and benefit from assistance in applying for and enrolling in coverage through the Marketplace.
A solid plan and resources to educate and guide people in transitioning from Medicaid to Marketplace coverage will be vital to helping eligible people stay covered. As a trusted partner to government agencies, Maximus can help. We assist over 60 percent of the nation’s Medicaid enrollees. We partner with seven state-based Marketplaces (including the District of Columbia) and the federal Marketplace (Healthcare.gov) to educate consumers and help them apply for and enroll in coverage. Regardless of whether the state operates a state-based Marketplace or uses the federal Marketplace, our consumer-centric approach combines technology and expert staff dually trained to assist people with the following Medicaid and Marketplace functions:
- Help consumers navigate upcoming coverage changes through omnichannel call centers to assist consumers in multiple languages.
- Design and execute broad-based consumer campaigns, including social media campaigns, to increase awareness of Marketplace coverage and the financial assistance available to eligible consumers.
- Conduct focused outreach to consumers losing Medicaid eligibility to educate them about the availability of Marketplace coverage.
- Educate consumers unfamiliar with the Marketplace about who is eligible to enroll, how financial assistance works to reduce the cost of coverage, and how to apply for coverage.
- Provide consumers with conflict-free information about the health plan options available through the Marketplace, including the services covered, monthly premium cost, deductibles, out-of-pocket costs, and information about the healthcare providers that work with the plan.
Maximus has nearly 50 years of experience working with states to help consumers navigate government programs. With deep expertise in assisting consumers in applying for and enrolling in Medicaid and Marketplace coverage, and as the nation’s largest conflict-free enrollment broker, Maximus has one goal: To work with our state partners to ensure that consumers who lose Medicaid coverage in the coming months have complete and reliable information about Marketplace options.