Big changes are coming for Medicaid members. If you’re covered under the plan, take a few minutes to learn what’s happening, how to prepare and avoid possible gaps in coverage.
What is the reason for the changes and what is Medicaid redetermination?
During the COVID-19 pandemic, all states were required to continuously enroll people in Medicaid. This ensured people had health care coverage during the public health emergency. During that time, millions of people were added to Medicaid.
Now that COVID-19 is less of a threat, the public health emergency ended on May 11, 2023. This means the special, Medicaid enrollment process has also ended.
Every state is starting the annual process again to confirm that Medicaid members still qualify for coverage. This process is called “Medicaid redetermination.” It ensures that people who need the coverage get it. It also helps the program stay financially strong.
How does Medicaid redetermination affect me?
Medicaid redetermination is happening right now. If you have Medicaid, your state will contact you to review your eligibility. Many haven’t had Medicaid eligibility checked for several years. In that time, you may have had life changes — like a new job or income change. This could affect whether you qualify for Medicaid.
This process affects millions of Americans. It is estimated that 8-24 million people will lose their coverage. This is because they’re no longer eligible for the program or they didn’t reapply.
How does it work?
The review process and timeline vary by state and will determine whether a member qualifies. It is based on age, income, disability status and household size.
What do I need to do to avoid a gap in coverage?
If you’re on Medicaid, take these three steps. The review process is already taking place, so take action today:
- Update your contact information. Your state Medicaid office needs to reach you. Do they have your current:
- Mailing address
- Phone number
- Email address
- Check your mail regularly. Your state will be mailing a letter letting you know if you need to complete a renewal form.
- Reply promptly. If required, complete your renewal form and return it as soon as possible to avoid a gap in coverage.
If you have questions about your state’s process and timeline, check with your state Medicaid office.
Your state will review your information and let you know if you’re still eligible for Medicaid.
- If you’re eligible for Medicaid: Your state will work with you to renew your Medicaid coverage.
- If you’re no longer eligible for Medicaid:
- Your state will inform you that your Medicaid coverage is ending on a certain date.
- You’ll need to find other health care coverage.
- If you are employed and don’t qualify for Medicaid and need health care coverage: Check with your employer about coverage available through your work.
- If you are not employed and don’t qualify for Medicaid and need health care coverage:
- You can buy your own health care plan.
- Learn about your options at healthcare.gov or 1-800-318-2596.
The most important takeaway: stay informed and take action. Get more information about this process and your options.