Medicaid eligibility redeterminations will resume in 2023. Here is what enrollees must know.

EDITOR’S NOTE: This text was first posted in March 2022 however has been up to date to mirror the passage of the Consolidated Appropriations Act, 2023 (the omnibus spending invoice). The COVID public well being emergency (PHE) is expected to be extended again in January 2023, however the omnibus invoice de-links the resumption of Medicaid eligibility redeterminations from the PHE, and permits states to begin processing eligibility determinations as of April 1, 2023.

This text has additionally been up to date to notice that the American Rescue Plan’s subsidy enhancements have been prolonged by the Inflation Discount Act.

The COVID-19 pandemic forged a highlight on the significance of the assorted security internet methods that the U.S. has in place. Medicaid is a main instance: As of August 2022, enrollment in Medicaid/CHIP stood at greater than 90 million individuals, with more than 19 million new enrollees since early 2020.

This enrollment progress – greater than 27% in two and a half years – was initially tied to the widespread job and revenue losses that affected hundreds of thousands of People early within the COVID pandemic. Happily, Medicaid was in a position to step in and supply well being protection when individuals misplaced their revenue. With out it, hundreds of thousands of extra People would have joined the ranks of the uninsured. We didn’t see that happen in 2020, thanks largely to the provision of Medicaid and CHIP.

However the continued enrollment progress in Medicaid is primarily due to the truth that the Households First Coronavirus Response Act (FFCRA), enacted in March 2020, has been offering states with extra federal funding for his or her Medicaid applications, so long as they don’t disenroll individuals from Medicaid through the COVID public well being emergency (PHE) interval. (As we’ll talk about in a second, the Consolidated Appropriations Act, 2023, has modified this rule).

And all states accepted the extra federal Medicaid funding. It’s noteworthy that the extra federal Medicaid funding that states have obtained is more than double the additional value that states have incurred to cowl the FFCRA-related enrollment progress.

There may be usually fairly a little bit of turnover within the Medicaid program, with some individuals dropping eligibility every month. However enrollment has trended upward all through the pandemic, with out the conventional disenrollments that beforehand stemmed from the common Medicaid eligibility redetermination course of. (Previous to the pandemic, states needed to recheck every enrollee’s eligibility at the least as soon as per 12 months, and disenroll individuals who have been now not eligible. That may resume in 2023.)

Spending invoice licensed states to renew Medicaid eligibility redeterminations

The PHE is expected to continue till at the least mid-April 2023. However that’s now not related by way of the resumption of Medicaid eligibility redeterminations. The Consolidated Appropriations Act, 2023 (enacted in December 2022) has given states a selected date – April 1, 2023 – after they can resume Medicaid eligibility redeterminations and start the method of terminating protection for enrollees who’re now not eligible. This course of is resuming after three years of being paused, so many present Medicaid enrollees have by no means skilled routine eligibility redeterminations.

Underneath the earlier guidelines (established by the Households First Coronavirus Response Act), states would have been allowed to begin redetermining Medicaid eligibility after the top of the month that the PHE ended. If it does certainly finish in April 2023, that may have meant that Medicaid eligibility redeterminations (and terminations) might have resumed as of Could 2023. However that was an unsure and ever-changing date, because the PHE has continued to be prolonged each 90 days. And though the Biden administration had promised states at least a 60-day notice earlier than the top of the PHE, states had famous that it was nonetheless proving very difficult to plan for the resumption of Medicaid eligibility redeterminations given the unsure timeframe.

Are there protections to make sure that enrollees who’re eligible for Medicaid will not be disenrolled?

There isn’t a doubt that some individuals at the moment enrolled in Medicaid are now not eligible on account of revenue will increase since they enrolled in this system. It’s comprehensible {that a} major purpose of the redetermination course of is to make sure that these people transition to different protection, both from an employer or by the alternate/market.

However there are very real concerns that many people who find themselves really nonetheless eligible for Medicaid may lose their protection on account of a lack of awareness of the method, onerous paper-based eligibility redetermination methods, unstable housing/communication conditions, and many others. HHS projects that just about 8% of present Medicaid enrollees will lose their protection – regardless of persevering with to be eligible – as soon as eligibility redeterminations resume.

So the Consolidated Appropriations Act, 2023 does require states to make use of the U.S. Publish Workplace’s change of deal with database and/or state Division of Well being and Human Providers knowledge to make sure that the state has up to date contact data for individuals whose protection eligibility is being redetermined. The legislation additionally prohibits states from disenrolling an individual merely primarily based on undelivered mail. The state has to make a good-faith effort to search out the particular person first.

There are additionally month-to-month reporting guidelines included within the legislation, designed to make sure transparency and accountability all through the unwinding of the FFCRA’s steady protection necessities.

We’re hopeful that states will work to make the redeterminations and renewals course of as clear, correct, and easy as attainable. However our purpose right now is that can assist you perceive what you want to know with a view to keep protection should you’re one of many hundreds of thousands of people that might probably lose Medicaid eligibility within the coming months.

When will Medicaid eligibility redeterminations occur?

Underneath the Consolidation Appropriations Act, 2023, the resumption of Medicaid eligibility redeterminations is no longer linked to the end of the COVID public health emergency. Instead, states can resume Medicaid eligibility redeterminations as of April 1, 2023, regardless of whether the PHE is extended again or not. March 31, 2023 is the last day that states have to maintain the continuous coverage rules that have been in place since March 2020.

But states have up to a year to initiate eligibility redeterminations for everyone who is enrolled as of April 1, 2023. This had already been the case under previous guidance that the Biden administration had issued, giving states 12 months to provoke the method and as much as two extra months to complete it. In a Could 2022 letter to governors, HHS famous “We strongly encourage your state to make use of the complete 12-month unwinding interval to place in place processes that can forestall terminations of protection for people nonetheless eligible for Medicaid as your state works by its pending eligibility actions.”

And the Consolidated Appropriations Act, 2023 gives for the extra federal Medicaid funding to step by step lower all through 2023, as a substitute of ending abruptly on the finish of the quarter wherein the PHE ends. If the PHE ends in April 2023, the FFCRA’s guidelines would have resulted within the extra federal Medicaid funding (6.2 share factors added to a state’s common federal Medicaid funding) ending altogether on the finish of June 2023.

This might have incentivized some states to behave as rapidly as attainable to disenroll individuals from Medicaid. However the Consolidated Appropriations Act, 2023 ensures that states proceed to obtain at the least some extra federal Medicaid funding all through 2023. For the primary quarter of 2023, states will proceed to get the 6.2 share level enhance that they’ve been receiving all through the pandemic. Within the second quarter, that can drop to five share factors. Within the third quarter, it can drop to 2.5 share factors, and within the fourth quarter of 2023, states will obtain 1.5 share factors in extra federal Medicaid funding.

For an individual who’s now not Medicaid-eligible beneath regular guidelines, Medicaid protection can finish as early as April 1, 2023. However the general tempo of Medicaid eligibility redeterminations and disenrollments will fluctuate significantly from one state to a different.

What number of will lose protection when the Medicaid eligibility redeterminations resume?

HHS projects that roughly 15 million individuals will lose eligibility for Medicaid as soon as the conventional eligibility redetermination course of resumes. However this is not going to occur unexpectedly, as every state may have its personal strategy to the resumption of eligibility redeterminations.

How may the Medicaid redeterminations have an effect on enrollees?

For those who’re nonetheless eligible for Medicaid beneath your state’s guidelines, you’ll be capable to hold your protection. You’ll have to submit documentation to the state to show your ongoing eligibility, so pay shut consideration to any requests for data that you simply obtain.

Many states have continued to send out these renewal notifications and information requests all through the pandemic. For those who’ve just lately submitted renewal data to your state and it’s clear that you simply’re nonetheless eligible, your protection will proceed as normal till your subsequent renewal interval.

For those who now not meet your state’s Medicaid eligibility pointers, it’s a good suggestion to know what your choices shall be when your state begins disenrolling people who find themselves now not eligible.

What are your choices should you’re now not eligible for Medicaid?

What in case your revenue has elevated to a degree that’s now not Medicaid-eligible? Or perhaps your circumstances have modified – maybe your revenue is identical however you’ve fewer individuals in your family and your revenue now places you at the next share of the poverty degree. There are hundreds of thousands of people that grew to become eligible for Medicaid in some unspecified time in the future since March 2020, and are nonetheless enrolled in Medicaid although they’d not be decided eligible in the event that they have been to use right now.

For these people, there’ll usually be two major choices for post-Medicaid protection: An employer-sponsored plan, or a plan obtained within the medical health insurance alternate/market. In accordance with an Urban Institute analysis, a few third of the individuals dropping Medicaid shall be eligible for premium tax credit (subsidies) within the market, whereas about two-thirds shall be eligible for employer-sponsored protection that meets the ACA’s definition of inexpensive. (Notice that the Biden administration has applied a repair for the household glitch, making some staff’ relations newly eligible for market subsidies in 2023 even with a suggestion of employer-sponsored protection.)

Most people who will change into eligible for market subsidies shall be adults, as youngsters are at all times a lot much less doubtless than adults to qualify for market subsidies. That’s as a result of Medicaid and CHIP eligibility for children extend to significantly higher income ranges, and market subsidies are by no means accessible if an individual is eligible for Medicaid or CHIP.

States can take motion to attenuate the quantity of people that change into uninsured on account of Medicaid eligibility redeterminations after the PHE. For instance, California is planning to automatically enroll individuals who lose Medicaid eligibility into the lowest-cost Silver market plan of their space (though they’d nonetheless have the conventional 60-day window to pick a special plan).

What do you have to do should you at the moment have Medicaid protection?

For those who’re at the moment enrolled in Medicaid, it’s a good suggestion to familiarize your self along with your state’s eligibility guidelines, and determine whether or not you’d be eligible should you have been to use right now, along with your present circumstances and revenue.

If the reply is sure, make certain you pay shut consideration to any requests for added data out of your state’s Medicaid workplace, as they could want that with a view to hold your protection in pressure.

But when the reply isn’t any, be ready for a protection termination discover in some unspecified time in the future after the top of March 2023.

What are my choices if I obtain a protection termination letter?

  • When you’ve got entry to an employer-sponsored well being plan, your lack of Medicaid protection will set off a particular enrollment interval that can assist you to enroll within the employer-sponsored plan. This window is only required to be 30 days, so don’t put this off.
  • For those who don’t have entry to an employer-sponsored well being plan, you possibly can apply for a premium tax credit score (subsidy) to offset the price of protection within the medical health insurance market in your state. Relying in your revenue, you may also qualify for cost-sharing reductions (CSR), which is able to make your out-of-pocket prices extra inexpensive so long as you choose a Silver-level plan (you should use premium subsidies with plans at any metallic degree, however CSR advantages solely include Silver plans).
  • The window to enroll in a market plan will begin 60 days earlier than your Medicaid protection ends, and can proceed for 60 days after it ends (HHS has proposed extending this window to 90 days as of 2024, with a view to permit individuals a possibility to attraction their Medicaid protection termination and nonetheless have an opportunity to enroll in a market plan if the attraction is unsuccessful. They’ve additionally proposed a rule change to forestall gaps in protection when an individual’s prior protection — usually Medicaid — ends mid-month). So as to have seamless protection or a minimal hole in protection, you’ll must submit your software earlier than your Medicaid ends. Your new market plan can not have a retroactive efficient date and gained’t take impact till at the least the primary of the month after you apply. So that you’ll have a spot in protection should you submit your market software after your Medicaid protection has terminated.
  • The subsidies which can be at the moment accessible within the market are notably beneficiant, because of the American Rescue Plan, and also you is perhaps pleasantly shocked to see how inexpensive the protection shall be. And the improved subsidies (ie, even higher than the Inexpensive Care Act’s authentic subsidies) will stay in place by the top of 2025, because of an extension granted by the Inflation Discount Act.
  • For those who’re in a state that hasn’t expanded Medicaid beneath the ACA and your revenue is under the poverty degree, you could end up within the protection hole that these states have created by refusing to increase Medicaid. HHS projects that 383,000 individuals who will lose Medicaid shall be within the protection hole. For those who’re making use of for a plan within the alternate and are being informed that you simply don’t qualify for any monetary help regardless of a low revenue, learn this text about methods for avoiding the protection hole. And familiarize your self with the revenue ranges that can make you eligible for premium and cost-sharing help within the alternate.

The principle level to remember is that the chance to transition to new protection, from an employer or by {the marketplace}, is time-limited. For those who miss your particular enrollment interval, you’ll have to attend till the subsequent annual open enrollment interval to enroll in protection (within the particular person market, that begins November 1; employers set their very own enrollment home windows).

New particular enrollment interval for low-income enrollees

There’s a new particular enrollment interval that permits individuals with family revenue as much as 150% of the poverty degree to enroll in protection year-round, for so long as the improved subsidies stay in place (so at the least by the top of 2025, and probably longer if Congress grants one other extension). And a few states that additionally supply extra state-funded subsidies permit individuals with increased incomes to enroll year-round.

For individuals whose revenue has elevated sufficient to make them ineligible for Medicaid, however nonetheless eligible for this particular enrollment interval, there shall be extra flexibility by way of entry to protection. However even should you’re eligible for this ongoing particular enrollment interval, it’s nonetheless in your greatest curiosity to submit an software as quickly as attainable should you discover out that you simply’ll be dropping your Medicaid protection. Free or almost free protection shall be accessible within the market for individuals eligible for this particular enrollment interval (this can be a results of the American Rescue Plan’s subsidy enhancements). And since protection can’t be backdated, it’s important to make sure that you’re lined earlier than any medical wants come up.

For those who don’t have entry to an employer-sponsored plan and you’re eligible for market subsidies (almost everyone seems to be), the perfect plan of action is to enroll in a market plan as quickly as that your Medicaid protection shall be terminated, with a view to keep away from or decrease a spot in protection. That is true no matter whether or not you’ll qualify for the brand new low-income particular enrollment interval, because you’ll have a traditional loss-of-coverage particular enrollment interval when your Medicaid ends, and you may make the most of it straight away.

Don’t panic: Protection is nearly definitely accessible.

The upcoming termination of FFCRA’s steady protection guidelines and return to enterprise as normal for Medicaid could be a nerve-wracking prospect for some enrollees. Many individuals who enrolled in Medicaid since early 2020 have by no means skilled the common eligibility redeterminations and renewal processes which have lengthy been part of Medicaid, and people will resume in April 2023 – or quickly thereafter, relying on the state.

The first issues to remember: Your Medicaid protection will proceed should you proceed to satisfy the eligibility pointers and submit any essential documentation as quickly because it’s requested by the state. And should you’re now not eligible for Medicaid, you’re virtually definitely eligible for an employer-sponsored plan or a backed plan within the market. Don’t panic, but additionally don’t delay, as your alternative to enroll in new protection will doubtless be time-limited.


Louise Norris is an particular person medical health insurance dealer who has been writing about medical health insurance and well being reform since 2006. She has written dozens of opinions and academic items concerning the Inexpensive Care Act for healthinsurance.org. Her state well being alternate updates are usually cited by media who cowl well being reform and by different medical health insurance consultants.