As of April 1, 2023, all states have resumed checking Medicaid eligibility (also called redeterminations) after a three year pause due to the COVID-19 pandemic. Under the Consolidated Appropriations Act of 2023 (CAA), states could begin redeterminations as early as February, with terminations for individuals found ineligible beginning as early as April. The CAA redeterminations process is known a Medicaid “unwinding.”
Four Important Things to Know About Redeterminations:
1. Many Medicaid enrollees remain eligible for Medicaid.
The CAA did not change eligibility rules for Medicaid, but it allows states to determine if individuals remain eligible based on the state’s existing income, asset, and functional eligibility rules. States must also determine eligibility for all Medicaid programs and transfer individuals to another Medicaid program, including Medicare Savings Programs, if eligible.
2. Enrollees should update their contact information.
While states are supposed to redetermine eligibility “ex parte,” meaning they use existing data to determine eligibility without having to contact the individual, state Medicaid agencies will still likely send out forms to most enrollees asking for additional information. Advocates should help individuals update their contact information, including address, phone number, preferred methods of communication, language preference, and other information to avoid unnecessary terminations.
3. Special Enrollment Periods (SEP) are available for Medicare and Marketplace coverage.
Individuals who are no longer eligible for Medicaid can enroll in either Medicare (if they are eligible) or the Marketplace.
- The Medicare SEP is available up to 6 months after an individual’s Medicaid coverage ends. The individual can choose to have Medicare coverage begin either the month after enrollment or retractive to the date their Medicaid ended. There will be no late enrollment penalties; however, individuals not eligible for a Medicare Savings Program may have to pay premiums if they choose retroactive coverage.
- The Marketplace SEP is available from April 1, 2023, to July 31, 2024.
4. Individuals have a right to appeal unfavorable decisions.
States must give enrollees notice of potential termination as well as information on how to appeal the decision and a right to a hearing.