August 4, 2022
3 minute read

What Every Medicaid Member Needs to Know About Redetermination

In September 2021, a research report from the Urban Institute made a startling prediction: When the pandemic’s public health emergency (PHE) ends, 15 million Medicaid beneficiaries could lose their coverage.1 (Medicaid is a federal and state program that helps with healthcare costs for some people with limited income and resources.)

The PHE was put in place to take care of the millions of Americans who were either out of work or earning less than normal due to nationwide COVID-19 lockdown orders. When the PHE is over, the federal government will redetermine the eligibility of millions of Medicaid and CHIP (Children’s Health Insurance Program) recipients. (CHIP is a federal health insurance program for children in families who earn too much money to qualify for Medicaid.)

What might this mean for you? Read on to learn what’s going on and what you need to do if you or a loved one is a Medicaid beneficiary.

Before you get any further, call a licensed insurance agent at (800) 827-9990 for more information about your healthcare options.

Medicaid Redetermination: how we got here

One of the federal government’s responses to the pandemic was the Families First Coronavirus Response Act, enacted in March 2020. This law offered states a 6.2% increase in funding for Medicaid and 4.34% for CHIP if they agreed not to disenroll any beneficiaries until the end of the PHE.2

Well, the PHE hasn’t ended. In April, Secretary of Health and Human Services Xavier Becerra extended it until July 15, 2022. And it’s now been extended 90 more days, until October.

When the PHE does end, states will have to figure out whether 85 million-plus Medicaid and CHIP beneficiaries across the country are still eligible for those benefits.4 Some will lose coverage because they got a job that put them above the income limit. Some will lose coverage because they’re now eligible for Medicare.

Others will lose coverage for less obvious reasons, says Tricia Brooks. She’s a research professor at Georgetown University who has studied the issue extensively. “They didn’t get the notice in the mail,” she says. “Or they didn’t know what they needed to do if they got it. Or they tried to get help from the call center and had a two-hour wait time. And at some point, they just get fatigued and sort of give up on the process.”

However, Brooks thinks the estimated 15 million dis-enrollments is low, but she also points out (as the Urban Institute did) that most children will be eligible for the Children’s Health Insurance Program (CHIP) and many adults will be eligible for coverage through the federal Affordable Care Act (ACA) website or their employer. (The ACA is a federal law that offers health insurance benefits to most Americans.) However, there may be barriers to accessing other coverage such as affordability.

Worried that you’re going to lose coverage? Call a licensed insurance agent at (800) 827-9990 to discuss your options.

What you should know about the timing of Medicaid Redetermination

States can’t start removing you from coverage until the end of the last month of the PHE. So if the PHE ends in October, no one could be disenrolled before November 1. However, Brooks says, the Biden administration has promised 60 days’ notice before the PHE will end.

States have 14 months to complete the process. According to a survey Georgetown University conducted with the Kaiser Family Foundation, 39 states plan to take nine to 12 months. In other words, it will take time for your state to process everyone, so you may still be getting coverage even after the PHE officially ends.

Even if someone is deemed ineligible for Medicaid or CHIP, they won’t be dropped right away. State plans have to send you a notice and give you 30 days to respond, says Brooks. “And then if they don’t respond, you have to give them at least a 10-day notice before they’re terminated from coverage,” Brooks says.

How states may handle your Medicaid Redetermination

Each state will have its own process for dealing with how you are redetermined. “States have been told that whatever approach they take, they should really be focusing first on people who have likely lost eligibility,” says Brooks.

For example, states might start with people who have turned 65 and are now eligible for Medicare. Or they might start with CHIP enrollees who have turned 19 and don’t qualify for Medicaid because they live in non-expansion states. Expansion states are ones that accepted additional funding under the Affordable Care Act (ACA) to cover all adults under 65, not just those with children.

At the same time, most states will look at data from sources such as the IRS to see if enrollees still meet the Medicaid income requirements and can be reenrolled automatically. According to that Georgetown University/Kaiser Family Foundation survey, 42 states have been conducting renewals during the PHE.5

What you need to do if you’re enrolled in either Medicaid or CHIP

Until the PHE ends, the Centers for Medicare & Medicaid Services recommends that enrollees sit tight, although they should make sure their state Medicaid office has their correct contact information. After that, they should check their mail and complete a renewal form on time if they receive one. If you think your Medicaid coverage could be ending, call a licensed insurance agent at (800) 827-9990 to explore your options. You can also browse plans online.

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We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE (TTY users should call 1- 844-704-7357), 24 hours a day/7 days a week, to get information on all of your options.

Attention: This website is operated by HealthMarkets Insurance Agency, Inc. and is not the Health Insurance Marketplace® website. HealthMarkets Insurance Agency, Inc. is licensed as an insurance agency in all 50 states and DC. Not all agents are licensed to sell all products. Service and product availability varies by state. Sales agents may be compensated based on a consumer’s enrollment in an insurance plan. No obligation to enroll. Agent cannot provide tax or legal advice. Contact your tax or legal professional to discuss details regarding your individual business circumstances. Our quoting tool is provided for your information only. All quotes are estimates and are not final until consumer is enrolled. Medicare has neither reviewed nor endorsed this information.

HealthMarkets Insurance Agency offers the opportunity to enroll in either QHPs or off-Marketplace coverage. Please visit HealthCare.gov for information on the benefits of enrolling in a QHP. Off-Marketplace coverage is not eligible for the cost savings offered for coverage through the Marketplaces.

This information is not a complete description of benefits. Call the Plan’s customer service phone number for more information.

48769-HM-0822

© 2022 HealthMarkets Insurance Agency. All rights reserved.

To send a complaint to Medicare, call 1-800-MEDICARE (TTY users should call 1- 877-486-2048), 24 hours a day/7 days a week). If your complaint involves a broker or agent, be sure to include the name of the person when filing your grievance.

We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE (TTY users should call 1- 844-704-7357), 24 hours a day/7 days a week, to get information on all of your options.

Attention: This website is operated by HealthMarkets Insurance Agency, Inc. and is not the Health Insurance Marketplace® website. HealthMarkets Insurance Agency, Inc. is licensed as an insurance agency in all 50 states and DC. Not all agents are licensed to sell all products. Service and product availability varies by state. Sales agents may be compensated based on a consumer’s enrollment in an insurance plan. No obligation to enroll. Agent cannot provide tax or legal advice. Contact your tax or legal professional to discuss details regarding your individual business circumstances. Our quoting tool is provided for your information only. All quotes are estimates and are not final until consumer is enrolled. Medicare has neither reviewed nor endorsed this information.

HealthMarkets Insurance Agency offers the opportunity to enroll in either QHPs or off-Marketplace coverage. Please visit HealthCare.gov for information on the benefits of enrolling in a QHP. Off-Marketplace coverage is not eligible for the cost savings offered for coverage through the Marketplaces.

This information is not a complete description of benefits. Call the Plan’s customer service phone number for more information.

48769-HM-0822

© 2022 HealthMarkets Insurance Agency. All rights reserved.

To send a complaint to Medicare, call 1-800-MEDICARE (TTY users should call 1- 877-486-2048), 24 hours a day/7 days a week). If your complaint involves a broker or agent, be sure to include the name of the person when filing your grievance.

We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE (TTY users should call 1- 844-704-7357), 24 hours a day/7 days a week, to get information on all of your options.

Attention: This website is operated by HealthMarkets Insurance Agency, Inc. and is not the Health Insurance Marketplace® website. HealthMarkets Insurance Agency, Inc. is licensed as an insurance agency in all 50 states and DC. Not all agents are licensed to sell all products. Service and product availability varies by state. Sales agents may be compensated based on a consumer’s enrollment in an insurance plan. No obligation to enroll. Agent cannot provide tax or legal advice. Contact your tax or legal professional to discuss details regarding your individual business circumstances. Our quoting tool is provided for your information only. All quotes are estimates and are not final until consumer is enrolled. Medicare has neither reviewed nor endorsed this information.

HealthMarkets Insurance Agency offers the opportunity to enroll in either QHPs or off-Marketplace coverage. Please visit HealthCare.gov for information on the benefits of enrolling in a QHP. Off-Marketplace coverage is not eligible for the cost savings offered for coverage through the Marketplaces.

This information is not a complete description of benefits. Call the Plan’s customer service phone number for more information.

48769-HM-0822