Due to the end of the public health emergency (PHE), Medicaid redetermination has resumed. If you and your family are currently covered by Medicaid, you might be wondering what this means for you. Understanding coverage can be stressful, but with the right resources, you can ensure proper coverage for yourself and your family.
This blog will discuss what Medicaid redetermination means, who it affects, and how you can prepare.
What you need to know
At the beginning of COVID-19, the federal government ensured families would not lose Medicaid coverage during the pandemic. The legislation paused Medicaid redetermination, typically a yearly event that determines whether those receiving Medicaid benefits are still eligible for coverage.
During the redetermination process, each state Medicaid agency reviews an individual's income, household size, and other eligibility criteria to ensure they still qualify for Medicaid coverage. If the state determines they no longer qualify for Medicaid, their coverage will be terminated.
- Medicaid retermination means that states have begun their process of checking eligibility for Medicaid coverage.
- You may no longer be eligible if you have had a pay increase or if you have not updated your personal information with your state.
There are three main reasons why people typically lose their Medicaid coverage:
- Income: their income has increased, and they now earn too much money to be eligible for Medicaid
- Age: they turned 65 and are now eligible for Medicare
- Lack of information: if the State does not have the information they need (for example, address and contact information)
If you fall into one of these categories, you will need to take action to continue coverage. The Centers for Medicare and Medicaid (CMS) is working with states to make sure to provide resources for families transitioning away from Medicaid.
Notices of redetermination
State Medicaid programs are required to send you notice of redetermination within 30 days to allow sufficient time for response. If you do not respond, the state must provide a 10-day notice before coverage is officially terminated.
Take action to ensure coverage.
To navigate the Medicaid redetermination process, families receiving Medicaid benefits should ensure their state Medicaid office has their correct contact information, including mailing address and phone number. If the Medicaid office requests additional information to verify eligibility, families should provide it as soon as possible and regularly check their email and mail for notices from the state Medicaid agency.
Completing the state's Redetermination Form for Medicaid online, which may require providing current address, household size, income, and information about other sources of health insurance, along with supporting documentation, is also essential.
Families should periodically check their Medicaid redetermination status by logging in to their state Medicaid agency's website or by calling their state office. Families should also ensure that healthcare providers like Hazel Health have updated health coverage information. If your insurance coverage changes, please provide your updated information to Hazel Health by calling 800-764-2935.
- Healthcare.gov - A government website that provides information on health insurance and options for coverage.
- Centers for Medicare and Medicaid Services (CMS) - The CMS is a federal agency that oversees Medicaid and provides assistance with the redetermination process. Their toll-free hotline, 1-800-633-4227 can offer support.
- State Medicaid agencies - Each state has its own Medicaid program. Individuals can contact their state agency for support with the redetermination process.
- Local Medicaid offices - Some states have local Medicaid offices that offer in-person services. Check with your state’s Medicaid agency to find out if this is an option for you.
Medicaid redetermination can be stressful for families receiving Medicaid benefits, especially after the pause during COVID-19 Public Health Emergency. Families can ensure they maintain coverage and access healthcare resources by taking the proper steps. Stay informed and contact healthcare providers if you need assistance during this process.