Effective July 1: Changes to Dual-Eligible Members’ Medicaid Benefit Coverage during Deeming Period
Overview
Wellcare By Meridian is updating benefit eligibility for members who have temporarily lost Medicaid and are awaiting confirmation that they will continue receiving Medicaid benefits.
Starting July 1, 2026, our plan will no longer pay for Medicaid benefits during the deeming period. We will continue to pay for Medicare benefits covered by our plan. We will also pay any Medicare cost-shares that Medicaid would have paid if the member had not lost Medicaid coverage.
What is a “Deeming” Period?
A member can be disenrolled from a Dual Eligible Special Needs Plan (D-SNP) if they no longer meet the enrollment criteria, including when Medicaid benefits are discontinued. A “deeming period” maintains D-SNP enrollment for a set period of time, if a member loses full Medicaid, and provides continued access to care. If a member restores their Medicaid eligibility before the deeming periods ends, they will not be disenrolled.
What providers need to know
- When a member is in “deeming,” services may still be provided based on medical necessity, and member financial responsibility may apply
- In some cases, members may be responsible for services if Medicaid eligibility is not fully re-established
- Services that are 100% Medicaid-funded (e.g., Home- and community-based service [HCBS]) are not covered during this period
- Authorizations issued prior to July 1 do not need to be canceled or resubmitted
- Providers should continue to:
- Verify eligibility at each visit. Both Availity Essentials and our secure provider portal display messaging when a member is in the “deeming” period.
- Inform patients of potential financial responsibility when appropriate
- Follow standard authorization and billing processes
