Returning to Medicaid Eligibility Redetermination: Here's What You Need to Know

After a hiatus of more than two years, states will resume Medicaid disenrollments effective April 1, 2023.

Medicaid enrollees are required to requalify every 6 to 12 months through the process known as redetermination. The Centers for Medicare and Medicaid Services (CMS) paused this requirement during the COVID-19 public health emergency (PHE). Instead, they allowed members to be continuously enrolled because of the support of federal matching funds, which will be phased out this year. Under the Consolidated Appropriations Act, 2023, states will be allowed to begin terminations on April 1, 2023. This has the potential to cause chaos in the healthcare industry.

What to Expect

Medicaid enrollment grew by roughly 25% during the pandemic, so the number of enrollees in the system is now higher than ever, resulting in an unprecedented number who need to go through redetermination. HHS expects 8.2 million Medicaid enrollees to lose their eligibility and 6.8 million eligible enrollees to lose coverage during the paperwork process if historical patterns hold true. To compound the issue, many current enrollees who gained coverage since March 2020 have never had to go through the redetermination process before. They may not know to look out for specific forms or even how to fill them out. If they do not participate in the process, the chance of losing coverage is almost certain. In addition, many enrollees will no longer qualify for Medicaid due to income changes. The initial economic downturn during the pandemic made it possible for many to qualify for coverage, but gains in the job market since then mean that the coverage some people qualified for 1 to 2 years ago may no longer be an option.

Act Now

Here are some tips you may share with members.

Make sure the state has your correct address.

States have different plans for how they will contact Medicaid members about what they need to do and the deadline for doing it. It is important to reach out to your state Medicaid office and update your address and phone number if it has changed recently. That way, members will receive important notices.

When you get a letter, act fast. 

When you receive a letter, open it right away because there will be a period to respond to make sure you have continuous coverage.

If you find out that your Medicaid coverage is going to end, look for new coverage as soon as possible.

Many people whose Medicaid coverage ends will qualify for employer-sponsored insurance or a subsidized premium on marketplace plans.

They will have a limited time to sign up for a health plan through their employer (if they offer it) or through the Marketplace.

2023 Poverty Guidelines

Click here to view the 2023 Poverty Guidelines for the 48 contiguous states and the District of Columbia, Alaska, and Hawaii. The new income and resource standards will be applied to all LIS (Low Income Subsidy) applications filed on or after January 1, 2023.

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