The following is important information for those who currently receive Medicaid benefits.

At the beginning of the pandemic, Congress passed legislation that ensured families would not lose Medicaid coverage during the COVID public health emergency. This means that people were allowed to stay on Medicaid – even if they weren’t officially eligible for it.

This protection is now ending. Beginning April 1, 2023, States will gradually start re-evaluating Medicaid eligibility for those families who no longer qualify for the program. According to research from the Kaiser Family Foundation, this redetermination will impact between 5 and 14 million people.

Additional background on Medicaid eligibility through the pandemic

Typically, low-income adults, children, some pregnant women, and people with disabilities are eligible for Medicaid. Before COVID, most states did yearly checks to ensure those who received Medicaid benefits were still eligible for the program. This process was called Medicaid Redetermination.

But, during the pandemic, the federal government offered increased funding to states for Medicaid – if the State agreed to pause Medicaid Redetermination.

Beginning April 1, 2023, Medicaid Redetermination will resume, which is expected to result in millions of people losing their healthcare coverage.

Typical reasons people lose their Medicaid eligibility

There are three main reasons that people typically lose their Medicaid eligibility.

Income: Some people lose Medicaid benefits because their income has increased and they now earn too much money to be eligible for the program.

Age: Some people lose Medicaid coverage because they turned 65 and are now eligible for Medicare.

Lack of Information: States sometimes use available electronic resources (such as those available through the IRS) during the Medicaid Redetermination process. However, the State occasionally sends a request for more information to the Medicaid recipient.

Unfortunately, sometimes a Medicaid recipient may lose coverage if the enrollee doesn’t respond to the request for more information.

When you may lose Medicaid coverage

It will take time for the States to complete each Medicaid Redetermination process, so you still may receive coverage even after April 1, 2023. Even if you are ineligible for Medicaid, you won’t be dropped from the program immediately.

In fact, State Medicaid programs must send you a notice and give you 30 days to respond. If you don’t respond, the State will give you at least a 10-day notice before your coverage officially ends.

What to do if you are currently receiving Medicaid benefits

There’s no reason to panic on April 1 – even if you think you no longer will qualify for Medicaid once the Medicaid Redetermination process is complete. However, you do need to be proactive.

Here’s what you need to do if you are currently receiving Medicaid benefits:

1. Make sure your State Medicaid office has your correct contact information, including your mailing address and phone number. 

The State office may contact you if they need additional information to help determine if you can continue to receive Medicaid benefits. You must respond to these requests for information.

2. If the Medicaid office requests more information to ensure your eligibility in the program, give it to them ASAP.

As mentioned, the State may drop you from the program if you don’t provide the requested information.

3. Enroll in Medicare – if you are 65 or older.

It’s been suggested that the first people to be cut from Medicaid may be those who have turned 65 and are now eligible for Medicare. However, you may incur penalties if you don’t sign up for Medicare when you are eligible, so complete this process immediately.

We walk you through signing up for Medicare here.

4. Complete your State’s Redetermination Form for Medicaid online.

Many states allow people who have Medicaid to complete the Medicaid redetermination form online. Log in to your state Medicaid account to complete the process.

You will most likely be asked to provide the following information on the form:

• Current address
• Household size
• Income information
• Information about any other sources of health insurance
• Documentation to support income and household information, such as pay stubs, tax returns, or proof of residency

It’s vital that you provide accurate, up-to-date information with valid documentation.

5. Periodically check your Medicaid redetermination status.

Log in to your state Medicaid agency’s website to learn about your current coverage status.

What happens next?

What happens next depends in part on your age. If you're under 65 and lost your Medicaid or CHIP coverage, the Centers for Medicare & Medicaid Services (CMS) announced a Special Enrollment Period (SEP) for this unwinding period of Medicaid continuous enrollment.

CMS calls this the "Unwinding SEP" and it will allow you to enroll in a Marketplace health insurance plan outside of the annual enrollment period.

You have from March 31, 2023 through July 31, 2024 to submit a new application or update an existing one at HealthCare.gov. To qualify for the Unwinding SEP, your last day of Medicaid or CHIP coverage must fall within that same 16-month window. After you submit your application, you then have 60 days to select a Marketplace plan, with coverage beginning the month after you make your selection.

What you need to know if you are 65 years or older: Medicare Special Enrollment Period

You must complete the Medicare sign-up process if you are no longer eligible for Medicaid because you are 65 years or older.

In fact, losing Medicaid coverage makes you eligible to sign up for Medicare during a Special Enrollment Period. This SEP lasts three full months from either the date you’re no longer eligible for Medicaid or the date you are notified, whichever is later.

During your Medicare Special Enrollment Period, you will be able to sign up for Medicare Part A (hospital insurance), Part B (medical insurance), and Part D (prescription drug coverage).

You may also use this period to sign up for a Medicare Advantage or Medigap plan (once you're enrolled in Parts A & B). If you aren't sure which choice is right for you, read our article, Pros & Cons of Medicare Advantage and Medigap Plans.

If you think you might be losing your Medicaid coverage, please call us at 888-992-0738. Our knowledgeable ClearMatch Medicare agents can help you understand your options.