Humana's Change Health Care (CHC) service restoration

CHC services have been partially restored with Humana, allowing Humana’s Enrollment Department to resume Medicaid eligibility verification processes. For many beneficiaries, this verification was paused during the CHC outage. With the eligibility verification resuming, Humana will deny enrollment requests if Medicaid eligibility cannot be verified.

Please note, there is no estimate at this time on when agent ability to perform eligibility checks via the D-SNP Eligibility Tool will be restored. This work is ongoing and future communication will be shared as more details are known. We are confident however, that an eligibility check tool will be available before AEP.

With the reinstatement of eligibility checks, Humana will also resume Medicaid eligibility verification of existing D-SNP members and re-initiate the deeming process for those members who do not have Medicaid eligibility.

What is deeming? The deeming period is the time in which a D-SNP member has lost their Medicaid status but remains on their existing plan. During this grace period, the member must either recertify their Medicaid status or find a new (non-D-SNP) plan. Humana sets this period to be 6 months for all states, with the exception of TN (3 months).

The deeming period begins the first day of the month following the month in which information is available to the D-SNP (and communicated to the member) regarding the member's loss of special needs status.

Anticipated Impacts
Members will begin to receive letters from Humana advising of either:

1. Initiation of the deeming period or 

Recipients: a) members who lost Medicaid eligibility between February -June; and b) members enrolled since 2/21 who are ineligible for the plan to which they are assigned.

2. Plan termination effective 7/31 

Recipients: members who entered deeming during the outage who will be afforded an additional 30 days to recertify or find a new plan before the 7/31 termination.What this means for agents

• Agents can reinforce the need for Dual Eligible Members to complete the redetermination process for continued Medicaid coverage should a member call regarding letters related to their Medicaid status.
• Dual Eligible Special Needs Plan (D-SNP) members, who are found to be ineligible for Medicaid coverage, will need agent assistance to obtain new coverage and maintain continuity of care.
• If the member elects to remain with Humana and meets all applicable eligibility requirements for a different plan of interest, agents can use SEP-SNP to process the enrollment.   
• Agents should make every attempt to secure a valid Medicaid ID number from applicants. If the Enrollment department cannot verify Medicaid eligibility using other demographic information on the application, the application will be denied. 
• As a reminder, the Medicare Eligibility Tool in Vantage and the Medicare check within the various Enrollment tools (which are fed by the CMS BEQ) are temporarily unavailable. Currently there is no timeline for restoration. For agents with MARx access, please use MARx as an alternative. Agents without MARx access should ask probing questions to determine enrollment eligibility, including asking if the beneficiary has their Medicare card available. 

Please be advised that a formal outreach initiative for members impacted by the CHC outage will be shared in July, with specific instructions related to agent BOBs.