In 2020, the COVID-19 pandemic created a public health emergency (PHE). In response, the U.S. Congress passed the Families First Coronavirus Response Act (FFCRA). This law suspended the requirement that state Medicaid agencies redetermine Medicaid beneficiaries’ eligibility for continued health coverage each year to help ensure that individuals had health coverage during the pandemic.

Before the pandemic, Medicaid beneficiaries had to renew their coverage annually to ensure they remained eligible for Medicaid benefits. Changes in income, household size, age and other factors can impact an individual’s eligibility. For the first time since March 2020, state Medicaid agencies have resumed coverage terminations as of April 1, 2023, for individuals redetermined as ineiligibe for Medicaid. Consequently, as many as 15 million Americans may soon no longer be eligible for Medicaid, according to estimates from the U.S. Department of Health and Human Services.

Losing your health coverage can be frightening; however, if you no longer qualify for Medicaid coverage, you may be eligible to enroll in a new health plan as part of a special enrollment period. This article explains Medicaid eligibility redeterminations, outlines why you might lose coverage and what happens if it’s lost, and discusses how to prepare for redeterminations.

What Are Medicaid Redeterminations?

Medicaid is a government program that provides health insurance to millions of eligible Americans with limited income and resources. Each state administers its own Medicaid program. Typically, Medicaid enrollees must apply annually to qualify for Medicaid benefits. This process is known as renewal, redetermination or recertification. The Medicaid redetermination process helps evaluate whether Medicaid enrollees are eligible for continued health coverage. Whether individuals currently enrolled in Medicaid remain eligible for continued health coverage depends on various factors, including changes in age, disability status, household size and income.

When Will Medicaid Redeterminations Resume?

State Medicaid agencies were able to begin processing eligibility redeterminations as of Feb. 1, 2023, and terminating coverage for enrollees who no longer qualify as of April 1, 2023, though the dates for terminating coverage will vary by state. States now have 12 months to initiate Medicaid renewals and 14 months to complete them.

The exact date of your Medicaid redetermination will depend on your state. Your state Medicaid agency will provide you with instructions for completing your Medicaid redetermination. Call 913-777-7740 for more information.

This is not intended to be exhaustive nor should any discussion or opinions be construed as legal advice. Readers should contact legal counsel or an insurance professional for appropriate advice. © 2023 Zywave, Inc. All rights reserved.