What Is Medicaid Redetermination? A Complete Guide
The Gist
The Medicaid redetermination process is under way, which means your state is going to check to see if you’re still eligible for the program. If you’re no longer eligible, you’ll lose your coverage later this year.
You’re most at risk of losing Medicaid if you increased your income or if you recently moved and haven’t informed your state of your new address.
Watch out for alerts from your state, which will let you know about any changes to your coverage.
Stride can help you navigate the confusing process of Medicaid unwinding and help you enroll in affordable new coverage if you lose your Medicaid coverage.
In This Article
In Short
Starting in April, the government is ending the pandemic policy that automatically approved and re-enrolled all Medicaid members. This means that if you currently have Medicaid coverage, you’re at risk of losing that coverage later this year.
If you’re wondering what Medicaid redetermination is and what this unwinding process might mean for you, we’re here to help. Understanding your options for health coverage can be stressful and confusing, but you don’t have to navigate the sea of choices alone. Stride is here to guide you through the entire process and answer any questions you might have about your upcoming enrollment options.
Here, we answer your common Medicaid redetermination questions and prepare you for potential changes to your coverage.
What Is Medicaid Redetermination?
Medicaid redetermination is the fancy name for a process by which your state checks whether or not you still qualify for Medicaid coverage. This process normally happens annually. But the government took a break for the last three years to ensure everyone had continual access to health care during the pandemic.
But now that annual redetermination process is starting back up. And if your state decides you’re no longer eligible for the program, you’ll lose your Medicaid coverage later this year.
Medicaid redetermination is also called:
Medicaid unwinding
Medicaid renewal
Recertification
Case review
Medicaid going away
Transitions from Medicaid to marketplace
Medicaid transitions in coverage
When Does It Take Effect?
The short answer: It depends on where you live. The Medicaid redetermination process varies by state.
That said, here are some general timelines to keep in mind:
February 1, 2023: The redetermination process starts. Your state can now check whether or not you still qualify for Medicaid.
April 1, 2023 to May 31, 2024: At some point during this period, your state will let you know if you still qualify for Medicaid and what, if anything, you need to do to continue your coverage.
April 1, 2023: This is the earliest possible date that your Medicaid coverage will end (the actual date your coverage ends depends on your state), though you may be able to keep your coverage as late as April 1, 2024.
March 31, 2023 to July 31, 2024: This is the special enrollment period during which you can get other health insurance if you’re losing Medicaid coverage.
Am I at Risk of Losing My Medicaid Coverage?
Remember, in some states, people can start losing Medicaid as early as April 1. But some people are more at risk of losing coverage than others. You’re most at risk if:
Your income increased
You were unemployed, but now have a job
You moved sometime in the last three years
Your state isn’t able to contact you (for example, this might be the case if you changed addresses and didn’t notify the Medicaid office)
But don’t worry — even if you fall into one of the above categories, there are still resources to help make sure you’re not left without any health insurance. For one, the Centers for Medicare & Medicaid Services (CMS) is working closely with states to make sure that the transition away from Medicaid happens smoothly and effectively. The CMS aims to reduce the impact on those most at risk of losing coverage, creating a priority system to ensure that the most eligible are not cut off first.
If you do lose Medicaid coverage, Stride is also here to help you quickly and easily enroll in new affordable coverage (more on that later).
How Can I Prepare for Medicaid Redetermination?
The potential of losing your coverage during redetermination for Medicaid can be stressful. Luckily, there are a few simple steps you can take right now to get ahead of the upcoming changes:
1. Make Sure Your Contact Information Is Up-to-Date
First, make sure your contact information (including your address, phone number, and email) is updated in your Medicaid portal so that you’re able to receive any communications your state sends you. You can also call your state’s Medicaid office to update your contact information over the phone.
2. Keep an Eye Out for Notifications
Watch for a Medicaid letter in the mail. It should arrive between April 1, 2023 and May 31, 2024. It’ll tell you if you need to fill out a renewal form to see if you’re eligible for continued Medicaid coverage. If you do, complete the form and send it to the address provided.
3. Apply for a Special Enrollment Period
If you’re not eligible to renew your Medicaid, the next step is to find new affordable coverage. You’ll qualify for a special enrollment period that runs from March 31, 2023 to July 31, 2024. A special enrollment period gives you the opportunity to enroll in a new health insurance plan in time for your loss of Medicaid coverage, rather than having to wait until November’s annual open enrollment period (where anyone can get new health insurance for any reason).
If you’re within 60 days of losing Medicaid, you can apply for the special enrollment period and a new plan all at once. If you’re losing Medicaid more than 60 days in the future, you have until 60 days after your coverage ends to apply for the special enrollment period and a new plan (more on how to do this in a moment).
Also note that you don’t have to wait for your Medicaid coverage to end to apply for new coverage and this special enrollment period. If you’ve already been notified that you’re losing Medicaid within the next 60 days, you can apply for affordable health insurance now so long as you can prove that your Medicaid coverage is coming to an end.
How Do I Get New Affordable Coverage?
While it may seem daunting to lose your Medicaid coverage, this change has the potential to pave the way for new and better insurance options that don’t break the bank (pro tip: Skip the short-term health insurance).
And Stride can help you discover those options quickly and easily so you don’t have to spend hours on government sites sifting through potential health plans. Stride, an official partner of HealthCare.gov, will search all available plans for you and recommend the best coverage based on your needs (like budget, health concerns, and preferred doctors). Stride will also check for tax credits that help lower the cost of your plan so you get the best possible price. In fact, 4 out of 5 people can find a plan for less than $10 per month.