State agencies across the nation today can begin unenrolling Medicaid recipients who are no longer eligible for benefits.
During the pandemic, they’d been directed to keep beneficiaries enrolled regardless of changes to their eligibility. That continuous coverage ended on March 31, though — about six weeks before the public health emergency will expire, on May 11.
During the COVID crisis, Medicaid enrollment grew by more than 30%, to more than 84 million people, according to the Kaiser Family Foundation. The “unwinding” of continuous coverage could see as many as 15 million beneficiaries lose coverage, the anti-poverty nonprofit reported.
Here’s what you need to know about what’s happening to Medicaid, including who’s losing coverage, when it’ll happen and what options are available.
For more information, learn how to find affordable health care without insurance and how to decipher medical bills to make sure you aren’t being overcharged.
What is Medicaid?
Medicaid provides free or low-cost health care coverage to low-income adults, children, pregnant women, seniors and people with disabilities.
It is funded jointly by states and the federal government and is administered by state agencies following federal guidelines.
Families with income that is too high to qualify for Medicaid can still get coverage for children through the Children’s Health Insurance Program, or CHIP, which covers medical and dental care for uninsured children up to age 19.
You can apply for Medicaid or CHIP here.
Who is losing Medicaid coverage?
While the largest segment losing Medicaid is people who are no longer eligible because they make too much money, it’s also possible to lose coverage for other reasons, including because you failed to report a change in family status (like getting married), you are no longer pregnant or you moved to a state with a different income cap.
According to estimations from the Department of Health and Human Services, up to 15 million people could lose Medicaid and CHIP benefits once continuous enrollment protections cease, including 5.3 million children and 4.7 million adults ages 18 to 34.
Minorities will also be disproportionately impacted: Nearly a third (30.7%) of those predicted to be dropped are Latino (4.6 million) and 15% (2.2 million) are Black.
HSS estimates that 45% (6.8 million) will be removed from Medicaid rolls even though they’re still eligible because of administrative obstacles such as difficulty navigating the renewal process, incomplete paperwork or an unreported change of address.
Casualties of this “administrative churning” will have to begin the process of reapplying for Medicaid or CHIP. Administrative churning may be “particularly high,” HHS warned in an issue brief, “due to the volume of redeterminations states must conduct and the time since Medicaid agencies last communicated with many beneficiaries.”
People who have moved since the start of the pandemic, those with limited English proficiency and people with disabilities are at greater risk of losing Medicaid coverage due to administrative churn, according to the Kaiser Family Foundation.
HHS said it was working with states to minimize churning and “facilitate enrollment in alternative sources of health coverage.”
When will I find out if I’m losing my Medicaid benefits?
States are required to review the eligibility of all Medicaid recipients at least once every 12 months. That process has been paused for three years, though, and it could take some time to review everyone’s income, household size and other information.
Congress uncoupled the continuous coverage requirement from the Public Health Emergency Declaration, which will expire on May 11. As a result, states were able to resume the renewal process on Feb. 1 and can now begin unenrolling ineligible beneficiaries.
Arizona, Arkansas, Florida, Idaho, Iowa, New Hampshire, Ohio, Oklahoma and West Virginia are among the states disenrolling ineligible beneficiaries this month, according to the Associated Press. Other states will wait until the summer, and many more will take up to a full year to finish unenrolling people.
How will I find out if I still have Medicaid coverage?
Check your mailbox. Your state agency will notify you by mail about coverage and will let you know if you need to fill out a renewal form to determine if you still qualify for Medicaid or CHIP. (They’re also required to remind recipients by phone, text or email.)
It’s important to make sure your state has all your current contact information so you don’t miss any important notifications.
Typically, you will have between 30 and 45 days to return the completed renewal form. If you don’t submit it in time, there could be a gap in your coverage.
How can I check my Medicaid status?
The Medicaid website has information and links for state agencies that oversee benefits. Find yours and contact it for the latest updates on your eligibility.
What are my options if I lose Medicaid?
Most people losing Medicaid coverage can turn to the Affordable Care Act marketplace. There will be a special enrollment period for individuals unenrolled from Medicaid beginning on March 31, 2023, and ending on July 31, 2024.
You’ll have up to 60 days from the time you are unrolled from Medicaid to register.
While you may end up with a plan with higher copays and a smaller pool of in-network doctors, the American Rescue Plan of 2021 expanded the Marketplace premium tax credit, a refundable credit designed to help lower-income individuals and families afford health insurance.
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The Inflation Reduction Act of 2022 extended that credit through 2025, and almost a third (2.7 million) of those losing Medicaid coverage are expected to qualify for it.
In addition, over 60% of those being dropped should be eligible for zero-premium Marketplace plans, according to HHS.
Another 5 million are expected to get medical coverage elsewhere, primarily through employer-sponsored insurance.