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Millions on Medicaid in Jeopardy as Pandemic Protections Expire

What to do if your state terminates your health coverage

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States around the country are beginning the process of removing an estimated 15 million Americans from Medicaid, the federal-state health insurance program for people with low incomes, as the pandemic-era moratorium on the annual review of enrollees’ eligibility for coverage comes to an end.

Whether you are eligible for Medicaid depends on such factors as your annual income and in some states what your assets are, such as savings or homes other than your primary residence. Before March 2020, Medicaid recipients typically had to fill out forms annually showing that they still qualified for the program. For the past three years, however, enrollees did not have to be recertified each year. The suspension of that requirement was part of the first coronavirus relief law that passed as unemployment soared and millions of Americans lost health benefits even as they were in danger of getting COVID-19.

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As part of a law enacted in December 2022, Medicaid is going back to its pre-pandemic rules. Starting April 1, Americans again have to demonstrate annually that they still qualify. Because each state administers its own Medicaid program, there is no one-size-fits-all way this process will work, but there are steps to take to prepare and options to pursue if you do lose Medicaid coverage.

 "The good news is there are things you can do now to prepare and lower your risk for losing Medicaid coverage," says Dan Tsai, director of the Center for Medicaid and CHIP (Children's Health Insurance Program) Services. "We are committed to making sure that everyone stays covered during this process. Please contact your state Medicaid agency with any questions."

Here’s what you need to know about the changes affecting Medicaid eligibility:

  • Every state is supposed to send letters to all its Medicaid beneficiaries. They will let them know how they can renew their coverage or if the state believes they no longer qualify for the program. When you get that letter will depend where you live. For example, five states — Arizona, Arkansas, Idaho, New Hampshire and South Dakota — have already started to determine who will be dropped from the Medicaid rolls and their letters have already started to go out. States have until June 2024 to complete this process.
  • If you are being dropped from Medicaid, you do have options for health coverage. If you are working, you can see if your employer offers a health plan you can afford. You can also see if you can get coverage through the Affordable Care Act (ACA). Losing Medicaid coverage qualifies as a “qualifying life event” so you won’t have to wait for the annual marketplace open enrollment period to get an ACA plan. You’ll also be able to apply for a subsidy to help you afford any monthly premium. According to one analysis, nearly one-third of people who are likely to be removed from the Medicaid rolls will be eligible for an ACA subsidy to help them afford health insurance.
  • Even if you get a letter saying you no longer qualify for Medicaid, you can still reapply, especially if your financial or medical situation has changed. There is no limit on how many times you can apply.
  • If you were on Medicaid when you turned 65 and you didn’t sign up for Medicare, you can apply now and not be subject to any late-enrollment penalty. You’ll have a special enrollment period that will start the day your state tells you that your Medicaid coverage is ending and will last for six months. You’ll have to apply for Medicare through the Social Security Administration.
  • If you are what is called a dual eligible — meaning you have Medicare and Medicaid — nothing will change unless you are told that you no longer qualify for Medicaid. If that’s the case, your Medicare coverage will continue unchanged.
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“Now is the time to make sure your state Medicaid program has your updated contact information,” says Jordan Endicott, an AARP government affairs director. “People could lose coverage just from not responding to a state’s letter.”

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Over 2.5 million older adults could lose eligibility

AARP’s state offices have been contacting state Medicaid officials to urge them to do all they can to make what is being called the Medicaid “unwinding” process as consumer-friendly as possible. 

In a letter to state officials, AARP calls this effort to determine the eligibility of millions of Medicaid recipients “a monumental administrative task, but the stakes are also incredibly high for the individuals that have come to rely on Medicaid health coverage during the COVID-19 pandemic.”

Between February 2020 and December 2021, Medicaid enrollment grew by more than 20 percent to nearly 87 million recipients from just over 71 million, according to federal government data. In a report issued last summer by the Department of Health and Human Services, officials estimated that more than 2.5 million older adults — 967,000 Medicaid recipients ages 45 to 54, 777,000 ages 55 to 64, and 791,000 age 65 and older — would no longer be eligible for Medicaid when the recertification process is done nationwide.

AARP is urging states to: increase the Medicaid workforce to handle this redetermination effort; streamline the verification process; give beneficiaries enough time to send the state the required renewal documents; make sure people know they need to update their contact information; and work with community organizations to help get the word out about this process.

“Going through this next year will be quite a challenge,” Endicott says, especially for people who signed up for Medicaid during the pandemic and have never been through a recertification process. 

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