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Employer Notice Obligation Under Medicaid and the Children’s Health Insurance Program (CHIP)

The Children’s Health Insurance Program Reauthorization Act of 2009 requires employers maintaining group health plans to notify their employees of the availability of premium assistance through the Medicaid or the Children’s Health Insurance Program (CHIP) in the state in which they reside. Forty states currently offer premium assistance, including Pennsylvania, Virginia and West Virginia. At this time, Maryland, Delaware and the District of Columbia do not offer premium assistance however, the legislatures in those states and the district may decide to offer it in the future.

Employees and dependents must contact their state’s Medicaid or CHIP office to determine if they are eligible for Medicaid or CHIP, to determine if their state provides premium assistance, and to find out how to apply for premium assistance. Accordingly, the employer-provided notice must include the participating state’s Medicaid or CHIP office contact information.

It is important to note that employers are required to provide notices to all employees who reside in participating states, regardless of whether or not they are enrolled in the employer’s group health plan. Thus, Maryland employers must provide the notice to employees residing in Pennsylvania, Virginia, West Virginia and any other participating states. Employers do not have to provide the notice to employees who reside in non-participating states, but may choose to do so if it is administratively easier. The notice is not required to be provided separately – it may be included in other materials such as open enrollment packages or Summary Plan Descriptions.

The notice must be provided by the later of (1) the first day of the first plan year beginning after February 4, 2010 or (2) May 1, 2010.

Examples:


  • For Plan Years beginning 2/5/10 thru 5/1/10, the notice must be provided by 5/1/10.
  • For Plan Years beginning after 5/1/10, the notice must be provided by the first day of the Plan Year. Accordingly, for 2010 calendar year plans, the notice must be provided by January 1, 2011.

The Department of Labor has provided a model notice on its website - www.dol.gov/ebsa/chipmodelnotice.doc

If you would like assistance with customizing the model notice or if you have any questions regarding your obligations, please call.








James T. Kimble
410-576-4178
jkimble@gfrlaw.com

Joy Napier-Joyce
410-576-4080
jnapierjoyce@gfrlaw.com

Matthew P. Mellin
410-576-4047
mmellin@gfrlaw.com

Robert C. Kellner
410-576-4239
rkellner@gfrlaw.com

This bulletin is designed to inform you of current legal developments and should not be construed
as legal advice or opinion concerning specific factual situations.

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Date

03.16.10

Type

Publications

Authors

Mellin, Matthew P.
Kellner, Robert C.

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