Now's the time to be prepared. There are..

Changes Coming to Medicaid

Beginning in April 2023, for the first time since early 2020, states can terminate Medicaid for people they have determined are no longer eligible. People enrolled in Medicaid may be required to submit current information about their household and income to stay enrolled in Medicaid.
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We can help you find out if you are at risk of having your Medicaid canceled. Reach out today....

What is the Medicaid continuous coverage requirement?

When the pandemic began in early 2020, Congress enacted several laws to help people and states get through the public health and economic crises.

One law gave states additional federal Medicaid funding as long as they keep people enrolled in Medicaid coverage during the COVID-19 public health emergency (PHE).

Under the continuous coverage requirement in effect until April 2023, people remain eligible for Medicaid even if they have a change in their income or family size that would have made them ineligible for Medicaid under normal circumstances, unless they voluntarily disenroll, move out of the state, or die. The policy has kept millions of people covered during the pandemic, ensuring they have access to health care services, including COVID testing, treatment, and vaccines.

When will the continuous coverage requirement end?

The requirement was originally linked to the COVID-19 Public Health Emergency (PHE). Continuous coverage was set to end the month after the PHE, as declared by the Secretary of the U.S. Department of Health and Human Services, expired. However, an omnibus spending bill enacted in December 2022 severs this link and instead sets March 31, 2023, as the end of the continuous coverage requirement, regardless of whether the PHE remains in effect.

How will the end of the continuous coverage requirement affect Medicaid?

States need to “unwind” the Medicaid continuous coverage requirement. Unwinding refers to the process of reviewing the eligibility of every person enrolled in Medicaid in the state to determine if they are still eligible. States have 12 months to initiate eligibility reviews of all their enrollees and can start reviews in February, March, or April. They can begin terminating coverage for people they determine are no longer eligible starting April 1. Each state is determining its own timeline, and most will spread their work over 12 months.
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How can you be prepared?

There are a few guidelines states must follow as they complete the unwinding process:

If the state can’t determine an enrollee’s eligibility using electronic data sources, then a renewal form will be mailed to the enrollee. Enrollees have at least 30 days to complete and return renewal forms to the state. People who don’t complete and return the renewal form could lose their Medicaid coverage. States must provide written notice at least 10 days prior to terminating coverage.
Some states allow enrollees to complete the renewal process online (including reporting changes and uploading verification documents) but others require documents to be mailed.

States must complete a full eligibility review using an enrollee’s current information

States must try to determine a Medicaid enrollee’s eligibility through electronic data sources (such as wage data) before mailing renewal forms. This process is called ex parte renewal.

States can’t terminate an enrollee’s coverage based on old information.

Eligibility: They are no longer eligible for Medicaid because their circumstances changed (income went up, household size went down, no longer pregnant, etc.).

Procedural: They lose their coverage because of administrative errors, barriers they face during the renewal process, or other reasons not related to eligibility. This includes people who remain eligible for Medicaid as well as people who are no longer eligible for Medicaid but may qualify for coverage through the marketplace, Medicare, or job-based coverage.

It's important to be prepared

Millions of enrollees could lose their Medicaid coverage during the unwinding process for oneof two reasons:

senior couple happy elderly love together retirement lifestyle smiling man and woman.

What should people enrolled in Medicaid do to stay covered?

States are currently mailing important notices and may begin mailing renewal forms in the coming months, so the most important step enrollees should take is to make sure the state Medicaid agency has their current mailing address and phone number.

What should people do if they lose their Medicaid coverage during this process?

People who lose Medicaid for procedural reasons have 90 days to contact the Medicaid agency and submit their renewal paperwork. If they’re still eligible for Medicaid, the state is required to restore their coverage back to the date their coverage was terminated. People who miss the 90-day window must submit a new application. People who lose Medicaid because they are no longer eligible will qualify for a special enrollment period (SEP) on HealthCare.gov or their state-based marketplace.

Enrollment Assistance

Letters from the Medicaid agency can often be confusing, so you may need help understanding the steps you need to take to keep Medicaid or enroll in another form of coverage. We are prepared to provide you with help to understand these letters, such as what documents they need to provide to the Medicaid agency to verify their eligibility, like pay stubs.

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