Pandemic-era protections that prevented people from losing their Medicaid coverage have already expired, and states will be expelling millions of beneficiaries in the coming months. This can affect their access to healthcare and expose them to expensive bills.
For nearly three years, the federal government has been sending billions of dollars in extra Medicaid funds to states on the condition that they do not remove enrollees from the program. But legislation enacted in December calls for gradually halting this influx of money and giving states the green light to expel beneficiaries who no longer qualify. Up to 15 million people could be left without health insurance.
The biggest challenge now is to make sure that people who qualify for Medicaid remain enrolled, and that those who do lose their benefits have access to other affordable coverage. As a consumer, the Medicaid beneficiary must be well-informed, knowing, among other things, that:
• Medicaid does not have a specific enrollment period, so members can update their information at any time or respond to any update request. This is key if you still qualify for the program to avoid being mistakenly removed.
• Beneficiaries cannot be removed immediately. The law prohibits the disenrollment of any person until the state has made a "good faith effort" to contact the person in several ways, including by mail, phone, or email.
• States will give recipients 60 days to respond to requests for information before removing them from the program.
• There will be a temporary special enrollment period (SEP) for people who lose Medicaid coverage in the more than 30 states covered under the federal health insurance marketplace. They will have until July 31, 2024, to enroll and obtain a plan in the markets established by the Affordable Care Act (ACA).
• If the person lives in a state that runs its own ACA marketplace, it will offer the same extension for open enrollment.
States will use government databases like those of the IRS or the Social Security Administration to check eligibility based on income so they can automatically renew coverage for some people without contacting them. This is called the Medicaid renewal or “redetermination” or “recertification” process.
They will also be working with community health centers and other neighborhood partners to inform everyone about changes to the Medicaid program and alternatives for those who no longer have health coverage.
The goal is to prevent people from ending up without health coverage during this transition.
All Medicaid beneficiaries should know that there are solutions to continue your health coverage if you risk losing that benefit.
In addition, remember that most people qualify for financial aid (tax credit) and other extra savings that may significantly lower the cost of health insurance.
