Medi-Cal Termination? You May Qualify for a Medicare Special Enrollment Period

Medi-Cal, special enrollment period, older woman reading mail, disappointed

As the unwinding of the Medicaid continuous eligibility requirements that were put in place during the COVID-19 Public Health Emergency (PHE) continues, older adults who have lost their Medicaid (Medi-Cal in California) may be confused as to what their options are. Should they enroll in Medicare? If so, how?

If they’re eligible for Medicare, the answer is yes. And they can do it through a new Special Enrollment Period created by the Centers for Medicare and Medicaid Services (CMS). Individuals can use this SEP to enroll in Medicare within 6 months of losing Medicaid without facing a late enrollment penalty and with little to no gap in coverage.

This is great news, as some older adults with full Medicaid (Medi-Cal in California) during the COVID-19 PHE may not have enrolled in Medicare when they became eligible during their Initial Enrollment Period (IEP). They already had full coverage via Medi-Cal. Medi-Cal was prohibited from making any terminations during the PHE. So they may have seen no need to also enroll in Medicare. Now, however, through the “unwinding” and redetermination processes with Medicaid, some of these older adults facing Medicaid termination need to enroll.

As the SEP is new, not all Social Security Administration employees may be familiar with it. In that case, advocates helping clients can give the specific SSA Program Operations Manual Systems (POMS) cite to the SSA employee to make sure they get enrolled quickly and smoothly: HI 00805.385 Exceptional Conditions Special Enrollment Period (SEP) for Termination of Medicaid Eligibility.

Karen Joy Fletcher

Our blogger Karen Joy Fletcher is CHA’s Communications Director. With a Masters in Public Health from UC Berkeley, she is the online “public face” of the organization, provides technical expertise, writing and research on Medicare and other health care issues. She is responsible for digital content creation, management of CHA’s editorial calendar, and managing all aspects of CHA’s social media presence. She loves being a “communicator” and enjoys networking and collaborating with the passionate people and agencies in the health advocacy field. See her current articles.