All Medicaid beneficiaries will undergo an eligibility review in the coming months.
If your health insurance benefits are provided by Medicaid and/or CHIP (Children’s Health Insurance Program), it is important to understand how redetermination could impact your health benefits in the coming months. This article explains redetermination, outlines why states are undergoing the redetermination process, provides information for how to prepare for redetermination, and includes resources for maintaining access to insurance coverage if no longer eligible for Medicaid or CHIP because of the redetermination process.
What is Redetermination?
Redetermination is a term used to describe the process of re-verifying eligibility for government health benefits such as Medicaid. All persons currently receiving Medicaid and/or CHIP benefits will undergo redetermination in the coming months. States must start the redetermination process by April 1, with many states starting as early as February 1. States will have 12 months to complete the redetermination process once they begin. Medicaid beneficiaries who fail to complete the redetermination process will lose their Medicaid benefits. To aid the process, the Federal Communications Commission (FCC) is allowing states and managed care plans to text beneficiaries.
Why are Medicaid and CHIP going through this redetermination period?
During the pandemic, the federal COVID-19 public health emergency mandate did not allow states to disenroll any of its Medicaid recipients. This significantly increased the number of Medicaid beneficiaries. Over the past two years, almost 1 in 4 Americans became Medicaid recipients.1 During the pandemic, the government floated federal money—Public Health Emergency (PHE) funds—to cover the growing Medicaid population. Those PHE funds are scheduled to expire May 11 of this year.
What can I do to prepare for the redetermination process?
Make sure your address, email, phone number, and other information are up to date. Make sure you get your Medicaid redetermination letter and/or text by assuring they have the most current contact information for you.
Check your mail and email, and check it frequently. Your state will contact you eventually, so be ready to respond. There is no “maybe” in this redetermination. This is certain. If your state requires you to complete a renewal form, do so promptly and return it via the listed address on the form. This will help avoid gap in your coverage.
Have your proof of income ready to share. Medicaid is a federal assistance program based upon an individual’s income and the federal poverty level. Proof of income will likely become a vital part of redetermination.
Where can I go to learn more about my state’s redetermination process?
Go to your state Medicaid’s website to learn more. The Hemophilia Federation of America has created a page including links, phone numbers, and information about each state’s Medicaid plans. Access the page here.
What if I am disenrolled from a Medicaid or CHIP plan as a result of redetermination?
If you are disenrolled but believe you are still eligible, you may go through the appeals process. You can read about that here or reach out to BioMatrix.
If, however, you are disenrolled because you no longer qualify for Medicaid or CHIP, you may be able to buy a plan through Health Insurance Marketplace at Healthcare.gov. Plans are comprehensive and can be as little as $10/mo.
The primary thing to remember is that if you meet your state’s Medicaid requirements and complete all the requested redetermination forms in the time frame requested, your Medicaid will stay in place. If you no longer qualify for Medicaid coverage, you will qualify for a “special enrollment period” and can secure coverage through the healthcare exchange.
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References
Pradhan, Rachana. “Why Millions on Medicaid are at Risk of Losing Coverage in the Months Ahead.” KHN. 14 Feb. 2022. https://khn.org/news/article/why-millions-on-medicaid-are-at-risk-of-losing-coverage-in-the-months-ahead/.
