Nearly 91 million Americans are enrolled in Medicaid and the Children's Health Insurance Program. But many could soon find that their enrollment has ended.
Under normal circumstances, Medicaid enrollees' eligibility status is redetermined at least once a year, and coverage is terminated if the person is no longer eligible. But Medicaid disenrollment was paused in March 2020, due to Medicaid continuous coverage requirements put in place with the COVID public health emergency. States will now be resuming routine Medicaid eligibility redeterminations and disenrollment.
The U.S. Department of Health and Human Services estimates roughly 15 million people to be at risk of losing Medicaid coverage after disenrollment resumes. A substantial number of Medicaid beneficiaries were enrolled under the continuous coverage requirements that, based on their eligibility factors, may no longer qualify them for Medicaid.
The process of resuming Medicaid eligibility redeterminations and disenrollment will vary from one state to another. But everyone who is enrolled in Medicaid will have their eligibility redetermined at some point between 2023 and 2024.
If you or a loved one are enrolled in Medicaid, you may not have been through the full renewal process before, depending on how long you've been enrolled. Here are six things to keep in mind to make sure you properly address your Medicaid eligibility.
1. Update your contact information and respond to your renewal packet.
It's important to make sure that your state Medicaid agency has your updated contact information on file. States are increasingly using multiple contact methods, including mail, email, phone calls and text messages, and will be sending reminder notices in addition to the renewal packets. But ultimately, if they don't receive your completed renewal information and can't verify your ongoing eligibility for Medicaid, your coverage will be terminated.
If you receive a Medicaid renewal packet in the mail, it's essential that you complete and return it by the deadline listed in the packet, so that the state can determine whether you're still eligible.
2. Don't assume you're no longer eligible.
Don't assume that you're no longer eligible for Medicaid and skip the renewal process. For example, Medicaid eligibility is generally based on how a person's income compares to the federal poverty level, but that amount is indexed each year and has increased throughout the pandemic. To qualify for Medicaid under the Affordable Care Act's Medicaid expansion rules, an adult would need to have earned income less than 138% of the federal poverty level, or FPL. Over the past few years, the defined FPL limit has increased, expanding the number of people who would qualify.
For example, in 2020 an individual earning less than approximately $17,600 may qualify, whereas in 2023 the qualification threshold has increased to approximately $20,000. While more Americans may potentially remain eligible for health insurance through Medicaid, an increase in the FPL generally signifies that basic living costs have also increased.
Additionally, your family size might have grown since you first enrolled in Medicaid. The FPL limit will adjust based on the number of people in your household; therefore, you may still be eligible even if your total household income has increased over the past few years.
So when you receive a renewal packet, you'll want to complete it and return it. If you're no longer eligible, the Medicaid agency will let you know. But you might find out that you're still eligible, even if you didn't expect it.
3. You can transition to other coverage if you lose Medicaid.
People who are no longer eligible for Medicaid will be able to transition to other coverage when their Medicaid ends. Although employer-sponsored health insurance plans and self-purchased plans have limited open enrollment windows, they also have special enrollment periods due to a qualifying life event that can occur anytime throughout the year. An involuntary loss of other health coverage, including Medicaid, is a qualifying life event for all types of health insurance coverage.
So if you're eligible for an employer's plan but haven't enrolled in it because you had Medicaid, you'll have a chance to join the employer's plan when your Medicaid ends.
If you need to purchase your own health coverage, you'll have an opportunity to enroll in a plan through the insurance marketplace in your state or directly from a health insurer in your state. Most people who purchase their own coverage may be eligible for financial assistance, but you can only get that if you enroll through your state exchange or federal marketplace. For more information visit healthcare.gov Opens in a New Window. See note 1
4. You can appeal or reapply for Medicaid.
If you receive a notification from Medicaid indicating that your coverage is going to be terminated, you have the right to appeal that decision.
And enrollment in Medicaid continues year-round and isn't limited to the sort of open enrollment periods and special enrollment periods that are used for other types of health insurance coverage.
So if you're still eligible for Medicaid but you get disenrolled anyway, you can reapply at any time. This might be useful to know, for example, if you forget to respond to the renewal packet, or if the Medicaid agency isn't able to reach you because your contact information has changed.
5. If you have TRICARE, Medicaid is secondary.
In most cases, TRICARE serves as secondary coverage if you have another health insurance plan. But that's not the case if the other health coverage is Medicaid. In that case, TRICARE is your primary coverage and Medicaid is secondary.
If you currently have TRICARE in addition to Medicaid and you're disenrolled from Medicaid, your secondary coverage will end, not your primary one.
And just like other types of employer-sponsored health insurance, loss of other coverage is a qualifying life event that will allow you to enroll in TRICARE, or, depending on your eligibility, make a change to your TRICARE coverage.
The special enrollment period for TRICARE is 90 days when you have a qualifying life event, which isn't the same for other types of coverage. Typically, you have 30 days to enroll in employer-sponsored coverage and 60 days for self-purchased coverage.
So if you're enrolling in any type of coverage using a special enrollment period triggered by the loss of Medicaid, pay close attention to the applicable deadlines.
6. Understand coverage options in your unique situation.
Many of the people who are disenrolled from Medicaid will have another source of health coverage that's readily available. But for some people, it won't be that simple.
If you're a young adult who has aged out of Medicaid for children — which typically has higher income limitation than Medicaid for adults — you may still be eligible for Medicaid. Review your state's adoption of the Medicaid expansion limits to determine your eligibility. If you apply for coverage through the healthcare.gov marketplace, your eligibility will be considered as part of your application, and you may be able to enroll in Medicaid at that point.
If you're in a state that hasn't adopted the Medicaid expansion like Texas or Florida, you may fall into the coverage gap that exists for some low-income adults. Assuming you don't have access to a plan through your employer, you may be able to receive subsidies for your health insurance plan when you apply for coverage through the healthcare.gov exchange.
If you're eligible to be added to a parent's health insurance, find out whether that might be a better option than purchasing your own coverage. There are no right or wrong answers in situations like that, as it depends on your circumstances.
Take action.
Some people who lose Medicaid might have multiple options available to them, and the best choice might not be obvious until they've considered all the available plans and their enrollment windows. So, it's essential to act promptly, both in terms of responding to a Medicaid renewal notice and, if necessary, getting enrolled in whatever replacement health plan you choose.
- Consider all your options. Your best choice may not be an obvious one, so it's important to review which options you have.
- Act promptly. Since enrollment windows are firm and limited, you don't want to delay and risk missing your opportunity to get coverage in place.
- Get help if needed. Research your options and talk to a specialist if needed.