Information that Medicaid members need to know about redetermination

If you’re enrolled in Medicaid, you may currently be benefitting from a COVID 19-era rule that has allowed millions more people than usual to enroll in Medicaid. (Medicaid is a federal program run by state governments that helps with health care costs for some people with limited income and resources.)

This was because, during the pandemic, millions of Americans were out of work or earning less than normal. States were not able to disenroll Medicaid or CHIP (Children’s Health Insurance Program) beneficiaries from the program. This means people could remain on Medicaid or CHIP even if they were no longer eligible for it. (CHIP is a federal health insurance program for children in families who earn too much money to qualify for Medicaid.)

But this rule is coming to an end soon. And that means that as many as 15 million people (or more) could be at risk of losing their Medicaid benefits. What might that mean for you? Read on to learn what’s going on and what you need to do if you or a loved one is on Medicaid.

Learn more about your healthcare options by calling a licensed insurance agent at (800) 827-9990.

Medicaid redetermination: How we got here

Normally, only certain people can enroll in Medicaid. It depends mostly on your income level. Certain pregnant women, children, and people with disabilities are also eligible.

If you get Medicaid benefits, your state may check that you are still eligible for the program every year. This process is called Medicaid redetermination (you may also see it called Medicaid renewal or Medicaid recertification).

If you’re still eligible for Medicaid, your state may then reenroll you in the program. If you are not, your state may disenroll you, and you’ll lose your Medicaid coverage.

But when COVID happened, the U.S. government paused the Medicaid renewal process. Congress also passed the Families First Coronavirus Response Act in March 2020.

This law was meant to help people who may have been forced out of work or were not earning enough money to support themselves during the pandemic. As part of it, the government offered states increased funding for Medicaid and CHIP if they agreed not to disenroll any Medicaid beneficiaries until the end of the Public Health Emergency (PHE).

At the end of 2023, Congress decided to “unlink” the Medicaid renewal pause from the PHE end date. And now the renewal pause will officially come to an end on March 31.

Beginning on April 1, states will have to start figuring out whether 90 million-plus Medicaid and CHIP beneficiaries across the country are still eligible for those benefits. Some will lose coverage because they got a job that put them above the income limit. Some will lose coverage because they’re now eligible for Medicare.

Others will lose coverage for less obvious reasons, says Tricia Brooks. She’s a research professor at Georgetown University who has studied the issue extensively. “They didn’t get the notice in the mail,” she says. “Or they didn’t know what they needed to do if they got it. Or they tried to get help from the call center and had a two-hour wait time. And at some point, they just get fatigued and sort of give up on the process.”

However, Brooks thinks the estimated 15 million people who will be disenrolled is low. But she also points out that most children will be eligible for CHIP and many adults will be eligible for coverage through the federal Affordable Care Act (ACA) website or their employer. (The ACA is a federal law that offers health insurance benefits to most Americans.) But there may be barriers to accessing other coverage such as affordability.

Worried that you’re going to lose coverage? Call a licensed insurance agent at (800) 827-9990 to discuss your options.

What you should know about the timing of Medicaid redetermination

States will gradually return to their normal, pre-pandemic Medicaid renewals over the next year. States were allowed to begin looking at renewals as early as February 1. But your Medicaid coverage cannot be terminated until April 1.

However, renewals and terminations won’t happen all at once. It will take time for your state to process everyone, so you may still be getting coverage even after April 1. So even if you’re deemed ineligible for Medicaid or CHIP, you might not be dropped right away.

State Medicaid plans must send you a notice and give you 30 days to respond, notes Brooks. If you don’t respond, the state will give you at least a 10-day notice before your coverage is terminated, she adds.

How states may handle Medicaid redetermination

Each state will have its own renewal process for Medicaid. “States have been told that whatever approach they take, they should really be focusing first on people who have likely lost eligibility,” says Brooks.

For example, states might start with people who have turned 65 and are now eligible for Medicare. Or they might start with CHIP enrollees who have turned 19 and don’t qualify for Medicaid because they live in non-expansion states. Expansion states are ones that accepted additional funding under the ACA to cover all adults under 65, not just those with children.

States are also encouraged to automatically renew enrollment for people when possible. As Brooks explains, “states are expected to tap data sources, like the IRS, to see if they can confirm ongoing eligibility before sending a renewal form or asking somebody to take action.” This means you could be automatically reenrolled without having to do anything.

What you need to do if you’re enrolled in either Medicaid or CHIP

Your state’s Medicaid office will contact you by mail or phone about renewing your Medicaid coverage. States were allowed to begin the process on February 1. But each state will set its own timeline and process for renewals.

The most important thing to do right now is to make sure that your state Medicaid office has your correct contact information (mailing address and phone number). Check your mail and complete your renewal form on time if you receive one. If you think your Medicaid coverage could be ending, call a licensed insurance agent at (800) 827-9990 to explore your options. You can also browse plans online.