Starting March 2020, when the COVID-19 pandemic was declared a national public health emergency (PHE), Medicaid beneficiaries were shielded from losing their health coverage. However, coverage protection will cease by April 2023, prompting yearly eligibility assessments. These ‘redeterminations’ will occur over a 12-month period.
What is Medicaid Redetermination?
Medicaid renewal, also known as redetermination, is a state-based process to verify continued eligibility based on financial and other requirements. The redetermination process was paused for three years due to the public health emergency, but now states are resuming normal procedures to review eligibility and update Medicaid rolls. If you are a Medicaid beneficiary, you may have to undergo your state’s renewal process to confirm your eligibility.
What does this mean to you?
As states return to standard redetermination processes, expect to undergo annual eligibility reviews. The timing of your redetermination may depend on when you first enrolled in the program. Certain states automatically renew coverage by cross-checking information against federal and state data, while others require beneficiaries to respond to renewal packets. Failure to reply by the indicated deadline may lead to loss of coverage. It’s crucial to respond on time.
*You will receive a notice in the mail from OHA between April 1, 2023, and January 4, 2024. You will have 90 days to respond.
What you need to do if you have Medicaid?
During Medicaid redetermination, you may need to take certain steps to maintain your eligibility.
- Update your contact information: It’s important to update your contact information during redetermination to ensure you receive any renewal notices or requests for information. You can update your contact information by contacting your state’s Medicaid agency or updating it online through your state’s Medicaid website. Keeping your contact information up-to-date can help you avoid losing Medicaid coverage due to missed renewal notices or failure to respond to requests for information.
- Wait for the letter. During redetermination, you may receive a renewal packet or letter from your state’s Medicaid agency. It’s important to wait for this letter and read it carefully. The letter will contain important information about your renewal process, including the deadline for responding and the documentation you need to provide to support your eligibility. If you don’t receive a renewal letter by the expected time, contact your state’s Medicaid agency to ensure that your contact information is up-to-date and to find out how to proceed with the renewal process.
- Respond to the notice. You may need to confirm your income, household size, residency status, and any changes in your circumstances, such as a change in income or job status. You may also need to submit documents, such as pay stubs or tax returns, to support your eligibility.
What are your options if you no longer qualify for Medicaid?
If you no longer qualify for Medicaid during the redetermination process, you may have other options for health insurance coverage. Some options include:
Marketplace coverage: You can apply for coverage through the Health Insurance Marketplace at healthcare.gov. Depending on your income and household size, you may be eligible for premium tax credits or cost-sharing reductions to help make coverage more affordable.
Medicaid expansion: Some states have expanded their Medicaid programs to cover more low-income individuals and families. If you live in a state that has expanded Medicaid, you may be eligible for coverage even if you don’t qualify for traditional Medicaid.
Employer-sponsored coverage: If you have access to health insurance through your employer, you can enroll in their plan during open enrollment or a qualifying life event.
Short-term health insurance: Short-term health insurance plans can provide temporary coverage for up to 12 months. However, they may not cover pre-existing conditions and may not provide the same level of benefits as traditional health insurance.
It’s important to explore your options and choose the coverage that best meets your needs and budget. If you need assistance, you can contact a licensed insurance agent.
If you have Medicare, Medicare Savings Programs can help you.
When might I lose my coverage?
In certain states, disenrollment from Medicaid could start as early as April 1, 2023. The redetermination process will be carried out over a 12-month period, and in some states, it may be based on the anniversary of when you enrolled in Medicaid, which could result in a longer process. You may not receive communication from your state’s Medicaid agency until early 2024, depending on your location.
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