Medicaid Recertification: What Enrollees Should Expect

In most states, Medicaid benefits typically require annual renewal. However, in response to the COVID-19 pandemic in 2020, the federal government temporarily suspended nationwide disenrollment procedures while increasing Medicaid funding. This ‘maintenance of eligibility’ was initially set to conclude on March 31, 2023.

As of April 1, 2023, continuous Medicaid coverage is no longer in effect, and the requirement for yearly renewal to maintain benefits has been reinstated in most states. All Medicaid recipients must reapply and undergo eligibility reassessment to sustain their coverage. This process is known as Medicaid Redetermination or Medicaid Recertification.

Do you understand how this impacts you and how to verify your continued eligibility for Medicaid? Keep reading for essential information on Medicaid recertification and what enrollees should anticipate in 2023.

Medicaid Redetermination Explained

In 2020, the COVID-19 pandemic disrupted the world, significantly straining healthcare systems and raising concerns among those dependent on government-funded healthcare programs.

In response to this crisis, the federal government not only augmented Medicaid funding but also temporarily suspended the annual renewal process. The government assured Medicaid beneficiaries nationwide continued coverage until the close of March 2023.

However, as a result of this prolonged Medicaid coverage due to the pandemic, some individuals may currently receive benefits they no longer qualify for. As a result, beginning on April 1, 2023, all U.S. states have initiated the Medicaid Redetermination process.

This means that the state will no longer automatically renew your Medicaid benefits. Instead, your eligibility for Medicaid coverage will need to be reevaluated. For most Medicaid recipients, this won’t pose an issue since the criteria for redetermining eligibility will generally remain the same as the standard criteria in your state.

Your Medicaid program eligibility will only be subject to review if you no longer meet these established requirements.

Understanding Medicaid Eligibility

To grasp the concept of eligibility redetermination, it’s essential first to comprehend the criteria for Medicaid eligibility.

Medicaid is a public healthcare system financed jointly by federal and state governments. Its primary purpose is to provide healthcare coverage to low-income individuals and families who cannot afford traditional medical insurance and cover their healthcare expenses.

To ensure that Medicaid benefits reach those truly in need, specific eligibility requirements are in place. These encompass citizenship, age, and residency prerequisites that all Medicaid applicants must satisfy. 

To be eligible, you must meet the following criteria:

  1. Be either a U.S. citizen or a qualifying permanent resident.
  2. Be at least 18 years old.
  3. Reside in the state where you are applying for Medicaid benefits.
  4. Possess a Social Security number or alternative proof of identification.

Medicaid offers healthcare coverage to low-income groups, including children, parents, pregnant women, older adults, and disabled individuals. Additionally, Medicaid provides certain benefits not offered by other government programs, such as nursing home care.

While Medicaid operates in all U.S. states, the specific criteria for eligibility can vary among these different applicant groups. Furthermore, it’s important to note that although most states chose to expand Medicaid coverage as part of the Affordable Care Act. Some states did not opt for this expansion.

Redetermining Eligibility

Your state’s Medicaid office will examine your most recent information to assess if you and your family still meet their eligibility criteria. If you do, there may be no need to complete redetermination forms. However, in case of discrepancies or uncertainty regarding your eligibility, they will contact you for a reapplication.

It’s essential to keep your information up-to-date, mainly if any changes have occurred. Additionally, it’s crucial to provide accurate and truthful details. Since Medicaid is a government-funded program, providing false information on a Medicaid application carries serious consequences.

Have there been alterations in your income since your initial Medicaid application? Have you relocated to a new address? Have you recently married or had a child? These life changes could impact your ongoing coverage.

If everything remains unchanged, and you continue to meet your state’s specified criteria, you can rest easy. You will receive confirmation that you still qualify for Medicaid, and your benefits will persist. If you no longer meet the eligibility criteria, you will be notified. 

Navigating The Medicaid Redetermination Application

We know that any process that requires you to give lots of personal information can be stressful. But navigating the Medicaid Redetermination application process isn’t difficult when you know what to expect. In many ways, it’s like applying for the program for the first time.

Medicaid eligibility criteria differ slightly from one state to another, but you’ll need the same types of documents for the redetermination process. These typically include: 

  • proof of your total household income
  • your most recent pay stubs 
  • recent proof of your residential address

Why is this type of information necessary? Medicaid is a federal and state-funded health insurance program for low-income households. That’s why, to prove you qualify for these benefits, you need to provide documents showing your total income. 

Your financial status is a crucial factor, but your eligibility for Medicaid will be determined according to other criteria, too. You need to be resident in the state where you are applying for Medicaid benefits. That’s why you’ll need proof of your residence as well.

The Schedule For Medicaid Redetermination

Close to 19% of Americans receive Medicaid benefits, so this redetermination process will take some time. Because of this, states have been given a maximum of 14 months for the entire process. Therefore, you could receive a renewal notice anytime before June 1, 2024.

To be sure that you receive your renewal notice:

  • Ensure that your local Medicaid office has all your contact information.
  • Give them your current mailing address, phone number, and email address.
  • If any of your contact information has changed, update it immediately.

The Advantages Of Completing Medicaid Redetermination

If you currently receive Medicaid benefits that you applied for before the COVID-19 pandemic and haven’t been asked to renew your application since April 1, 2023, you will be asked to do so soon. It’s in your best interests to comply, as you stand to lose your coverage if you don’t. 

The advantages of completing the Medicaid Redetermination process are clear: 

  • Eligibility Confirmation: It clarifies whether you and your family still qualify for the vital benefits you rely on.
  • Continued Coverage: If your eligibility is affirmed, you’ll maintain access to Medicaid benefits and quality healthcare.
  • Prompt Decision-Making: If you’re found to be ineligible for Medicaid, you’ll be informed, allowing you to make alternative arrangements swiftly. This ensures ongoing access to healthcare and peace of mind.

Regardless of  what happens with the renewal process, you’ll have the knowledge you need to make informed decisions about your healthcare.

Appealing A Medicaid Redetermination Denial

Despite every effort at thorough fact-checking and eligibility determination, mistakes are always possible. So, if you think your state’s Medicaid office has made a mistake when denying you coverage, you can appeal their decision.

Regardless of where you live, your state must allow you to ask for a fair hearing about a Medicaid coverage denial. Bear in mind, though, that the appeal process may differ from one state to the next. Check the rules at your local Medicaid office before appealing.

What If I No Longer Qualify For Medicaid? 

While the various states initiate their Medicaid Redetermination processes, Medicaid recipients from low-income households are understandably concerned. What if you don’t qualify for Medicaid anymore? Fortunately, you can still access quality healthcare, no matter your financial status.

The opportunity to enroll in a marketplace plan opens 60 days before your Medicaid coverage expires. 

This is a recently introduced special enrollment period declared by the federal government in January 2023. 

Individuals experiencing a loss of Medicaid between March 31, 2023, and July 31, 2024, can enroll in a plan during this entire period. This is a more lenient approach than the standard rules where the special enrollment period terminates 60 days post-coverage loss. 

State-run exchanges offer this special enrollment period or follow their usual process, which starts 60 days before you lose your coverage and ends 60 days after. Regardless of your choice, it’s vital to apply for a new plan before your Medicaid ends to avoid a coverage gap.

Remember, your new marketplace plan won’t cover you retroactively. It will only start on the first day of the month after you apply. So, if you apply after your Medicaid coverage ends, there will be a gap in your coverage.

Employer-sponsored Health Plan

If you lose your Medicaid coverage and have access to an employer-sponsored health plan, you’ll have a 60-day special enrollment period to sign up for the employer’s plan. Don’t delay, as this is your opportunity to ensure uninterrupted healthcare coverage.

Marketplace Plan 

One of your best options is to get an affordable health insurance plan that, like Medicaid, is subject to the rules of the Affordable Care Act (ACA). There are different types of ACA plans available in every state. Your choice will depend on your medical needs, family obligations, and, of course, your healthcare budget. 

When you sign up for one of these plans, you’re guaranteed essential health benefits like emergency medical treatment, hospitalization, and maternity care. And sign-up is quick and easy when you have help from a trusted broker like Enhance Health

Helpful Resources

The most common queries about Medicaid Redetermination revolve around eligibility. The qualifying criteria for Medicaid can differ slightly between states. This is why it’s better to check directly with your state’s Medicaid offices.

Visit the Medicaid website and locate your state’s name in the alphabetical list. The Medicaid beneficiary resources information will be under your state’s listing. You’ll find your local office’s phone numbers, links to their eligibility criteria and enrollment information, and more.

Frequently Asked Questions Regarding Medicaid Redetermination

What if I don’t have all the documents to prove my eligibility?

Sometimes, the state can verify eligibility electronically. This is called ex parte renewal and relieves you of the burden of providing documentation. But if any information they need is not available via their electronic resources, you will receive a request for those specific documents. 

I am in the process of moving to another state. How will this affect my Medicaid Redetermination? 

Every state has its rules and regulations, and you may find that your eligibility does not continue after you move. So, if you move to another state, you must reapply anyway. Inform your local Medicaid office you’ll be moving. Once you arrive at your destination, you may immediately reapply.

Does Medicaid Redetermination apply to my child’s CHIP coverage as well? 

Yes. The Children’s Health Insurance Program (CHIP) provides health coverage to children from eligible households through both Medicaid and separate CHIP programs. The Medicaid renewal process includes children covered under the Children’s Health Insurance Program (CHIP).

Conclusion

Even if you were once eligible for Medicaid benefits, you may no longer meet the eligibility criteria. You’ll have to go through the Medicaid Redetermination process to be sure. But even if you no longer qualify, you don’t need to go uninsured. 

There are many health insurance plans to choose from at various price points. One of our trained professionals at Enhance Health can help you find a plan that best suits your needs. Subsidies are also available for Americans who are unemployed or earn very little. So give us a call and we’ll help you find a plan that offers quality healthcare at a price you can afford. 

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