Last reviewed October 2026

Does an employee get a special enrollment right when Medicaid or CHIP approves premium assistance for the employer plan?

Short answer: Yes. An eligible employee or dependent who is determined eligible for Medicaid or CHIP premium assistance toward the employer plan has at least 60 days from that determination to request enrollment.

CHIPRA created two special enrollment events for group health plans: losing Medicaid or CHIP because of loss of eligibility, and becoming eligible for state premium assistance toward the employer plan. Each gives at least 60 days, double the usual 30-day window for other special enrollment events.

The clock for the premium-assistance event starts on the date the person is determined eligible for the assistance. Simply gaining ordinary Medicaid or CHIP is not this event.

In Texas, an insured plan must also accept an enrollment on HHSC’s written HIPP notice regardless of enrollment periods; coverage starts on the date in the notice or the first of the month beginning at least 30 days after the insurer receives it. Ask the employee for the HHSC letter and send the request to the carrier or administrator right away.

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