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DOL Update: Eligibility for Premium Assistance Under Medicaid and CHIP

Krugliak, Wilkins, Griffiths & Dougherty Co., L.P.A.

The Department of Labor recently published a Model Notice for Employers regarding eligibility for premium assistance under Medicaid and the Children's Health Insurance Program (CHIP). The Department of Labor’s model notice is available here.

An employer that maintains a group health plan in a state that provides medical assistance under a state Medicaid plan under title XIX of the Social Security Act (SSA), or child health assistance under a state child health plan under title XXI of the SSA is required to notify each employee of potential opportunities currently available in the state in which the employee resides for premium assistance under Medicaid and CHIP for health coverage of the employee or the employee's dependents. 

As of Jan. 22, 2010, the following states offer one or more programs that meet this standard: Alabama, Alaska, Arizona, Arkansas, California, Colorado, Florida, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Massachusetts, Minnesota, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, Texas, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin and Wyoming.

If a company has employees in any of the 40 states listed above, they must meet the DOL notice requirement and may use the model notice to meet that requirement. Please note that Ohio does not have a CHIP premium assistance program and, as a result, employers who have employees only in Ohio are not subject to this requirement. 

An Employer CHIP Notice must inform each employee, regardless of enrollment status, of potential opportunities for premium assistance in the State in which the employee resides. The State is which the employee resides may or may not be the same as the State in which the employer, the employer's principal place of business, the health plan, its insurer, or other service providers are located. Employers subject to the requirement must provide the employer CHIP notice at least annually. The initial notice must be distributed by the later of the first day of the first plan year after February 4, 2010, or May 1, 2010. For calendar-year plans, the first notice need not be provided until January 1, 2011.

If you have questions about providing this model notice or your obligations to comply, please contact Michael Bogdan or your attorney at Krugliak, Wilkins, Griffiths & Dougherty.

NOTE: This general summary of the law should not be used to solve individual problems since slight changes in the fact situation may require a material variance in the applicable legal advice.

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