Medicaid is a government-run program that offers health insurance coverage to individuals and families who are low-income, disabled, or elderly. This vital program helps millions of Americans access healthcare that they otherwise couldn’t afford. However, in order to maintain Medicaid coverage, beneficiaries must go through the Medicaid redetermination process every year. In this article, we will explore what Medicaid redetermination is, how it works, recent updates on the process, and how to complete the Medicaid redetermination form online.

What is Medicaid redetermination and how does it work?

Medicaid redetermination is the process by which a beneficiary’s eligibility for Medicaid is reviewed and updated annually. During the redetermination process, the state Medicaid agency will review the beneficiary’s income, household size, and other eligibility criteria to ensure that they still qualify for Medicaid coverage. The redetermination process is crucial because it helps to ensure that Medicaid resources are being used appropriately and that the program is providing coverage to those who need it most.

If a beneficiary fails to complete the redetermination process or if the state determines that they no longer qualify for Medicaid, their coverage will be terminated. It is important for beneficiaries to complete the redetermination process as soon as possible to avoid any gaps in their healthcare coverage.

Recent updates on Medicaid redetermination

Due to the COVID-19 pandemic, the Medicaid redetermination process has undergone some changes. The Centers for Medicare & Medicaid Services (CMS) has issued guidance to states that allows them to extend Medicaid redetermination deadlines for up to 12 months. This extension is meant to help ensure that individuals who may have difficulty completing the redetermination process during the pandemic are not at risk of losing their coverage.

In addition, some states have implemented other changes to the redetermination process. For example, some states are allowing beneficiaries to complete the redetermination process over the phone or online instead of in-person. Other states are simplifying the redetermination form or allowing beneficiaries to self-attest to their income instead of providing documentation.

It is important for beneficiaries to check with their state Medicaid agency to see what changes have been made to the redetermination process in their state.

What to do if you lose your Medicaid coverage

In the year that following a disenrollment from Medicaid/CHIP, around two-thirds (65%) of people had a period of uninsurance while only 35% were continuously enrolled in coverage. So what can you do if you lose your Medicaid coverage? If this happens to you, a Special Enrollment Period (SEP) opens up for you beginning on the day you lose your minimum essential coverage. During this 60 day period, you can enroll in health insurance known as an Affordable Care Act (or Obamacare) plan. Typically, you are able to find a Marketplace plan, employer-sponsored coverage (ESC), or in the future enroll in Medicare if you lose your Medicaid coverage. 

If you receive an offer for ESC that is not affordable for you or doesn’t meet the minimum value, you may be eligible to enroll in a Marketplace plan with financial assistance.

How to fill out the Medicaid redetermination form online?

Many states now allow beneficiaries to complete the Medicaid redetermination form online. To do so, beneficiaries will need to visit their state Medicaid agency’s website and log in to their account. From there, they can find the redetermination form and complete it online.

The specific steps for completing the redetermination form will vary depending on the state. However, in general, beneficiaries can expect to provide information about their household size, income, and any changes to their circumstances since the last redetermination. They may also need to provide documentation to support their income and household information.

What do you need for Medicaid redetermination?

When completing the Medicaid redetermination form, beneficiaries will need to provide a variety of information and documentation. Some of the information that may be required includes:

• Current address and contact information
• Household size
• Income information, including information about any changes in income since the last redetermination
• 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

Beneficiaries should also be aware of some general guidelines for completing the redetermination process include:

• Completing the redetermination form as soon as possible to avoid any gaps in coverage
• Providing accurate and up-to-date information on the form
• Responding promptly to any requests for additional information or documentation from the state Medicaid agency

COVID delays

This process typically occurs on an annual basis, and failure to comply with the requirements can result in the loss of Medicaid benefits. However, the COVID-19 pandemic has led to significant delays in the redetermination process for many Medicaid beneficiaries, causing uncertainty and potential loss of coverage. While many states have implemented changes to the Medicaid redetermination process to account for the COVID-19 pandemic, there may still be delays in the process. 

Additionally, the pandemic has created challenges for individuals in accessing necessary documentation and submitting it to Medicaid agencies. Many people have lost their jobs or experienced disruptions in their income, making it difficult to provide the necessary proof of income and residency. Other barriers to completing the redetermination process may include difficulty accessing transportation, internet access, and language barriers.

The delays in the redetermination process have led to significant consequences for Medicaid beneficiaries. In some cases, individuals have lost coverage or can’t qualify for Medicaid renewal due to missed deadlines, failure to provide updated information. For others, the uncertainty of whether or not their coverage will continue has caused stress and anxiety. This is particularly true for individuals who rely on Medicaid to manage chronic conditions or access necessary medical care.

Medicaid agencies and advocates have recognized the challenges facing enrollees during the pandemic and have taken steps to mitigate the impact of redetermination delays. Medicaid agencies have also implemented outreach and education campaigns to help individuals navigate the redetermination process, such as providing information on acceptable forms of documentation and assistance in completing paperwork. The Consolidated Appropriations Act, 2023 calls for the continuous coverage requirement to end on March 31, 2023. So, states will be able to resume Medicaid disenrollments starting April 1, 2023.

The U.S. Department of Health and Human Services (HHS) currently projects that 17.4 percent or 15 million individuals) of Medicaid and Children’s Health Insurance Program (CHIP) enrollees will leave the program based on historical patterns of program loss. Additionally, HHS has predicted that 9.5 percent, or 8.2 million individuals, will leave Medicaid due to loss of eligibility. States are directly responsible for eligibility redeterminations, while CMS provides technical assistance and oversight of compliance with Medicaid regulations. The Inflation Reduction Act of 2022 extends the ARP’s enhanced and expanded Marketplace premium tax credit provisions until 2025, providing a key source of alternative coverage for those losing Medicaid eligibility.

How to get individual and family health insurance if you don’t qualify for Medicaid

If you no longer qualify for Medicaid, and are looking for an Affordable Care Act health insurance plan for you or you family, eHealth is here to help. eHealth’s team of licensed agents and our free online tools can weigh your options based on your budget and needs to find the right health insurance plan from a trusted health insurance carrier.

Even if you don’t qualify for Medicaid, you may qualify for an ACA health insurance subsidy, which can significantly help with the price of health insurance coverage. To learn more about subsidies and find the right health insurance plan for you and your family, check out the individual and family health insurance plans available at eHealth.