What you need to know: Medicaid redetermination
If you’ve been asked to renew your Medicaid plan or coverage, you may be asking, what should I do next? Why am I being asked to do this now?
If you have a Medicaid plan through your state, you may be required to go through a renewal process called redetermination in order to maintain your health coverage.
Here’s what you may need to know.
What is redetermination? Why is it happening now?
Medicaid redetermination, also called renewal or recertification, is the process through which Medicaid agencies redetermine an enrollee remains eligible for Medicaid. This is typically done annually. However, during the COVID-19 public health emergency (PHE), states were required to maintain coverage for all individuals enrolled in the program during this period. Some individuals have not had their eligibility reviewed since 2020 or earlier.
With the passage of recent legislation, states are required to resume the redetermination process and begin reviewing all current Medicaid enrollees to determine their current eligibility.
What does this mean for people who currently have Medicaid coverage? When will states reach out?
State Medicaid agencies were allowed to start processing Medicaid redeterminations on February 1, 2023, and may terminate coverage for people who long qualify as soon as April 1, 2023. However, state Medicaid agencies may process redeterminations over the course of many months and the process can vary based on the state and Medicaid program the person is enrolled in. While states have considerable flexibility on the resuming the redetermination process, states have 12 months (through March 31, 2024) to initiate redeterminations and complete the renewals within 14 months (through May 31, 2024).
What can Medicaid members expect during this review process? Will they be told immediately what their status is?
State Medicaid agencies will contact enrollees in advance of redetermination activities. Some states are working with Medicaid partners, such as managed care organizations and community-based organizations, to outreach to enrollees in order to ensure continuity of coverage.
Contact may be via postal mail, email, or other ways that are on file with the Medicaid agency. Enrollees may be asked to update their eligibly information, and include income documentation and other change in circumstance relevant to eligibility. Depending on the state, enrollees may also be able to see their redetermination dates and requirements on the state’s Medicaid electronic portal.
In some states and situations, a Medicaid enrollee may not have to do anything during the redetermination process because that state is able to use available data to confirm eligibility, including tax returns, unemployment, and eligibility in other government programs. In those situations, enrollees should receive notice that they have been approved or denied coverage and on what basis.
In other states and cases, Medicaid enrollees may have to complete a redetermination form via paper, online, or in person. Proof of income and other documentation may be requested.
How can Medicaid members prepare for this review?
- Make sure your contact information is updated. If your state Medicaid agency is trying to contact you, they need your most up-to-date information. Make sure your state Medicaid agency has your current mailing address, phone number, email, and other contact information.
- Keep an eye out for information from your state Medicaid agency. This might be one of the simplest yet effective ways to make sure you do not lose coverage. Look for official letters, forms, emails, or phone calls from your state plan. It will let you know if you need to renew.
- Complete your renewal form (if you get one) – fill out the Medicaid renewal form and return it to your state Medicaid agency right away to help avoid a gap in Medicaid or CHIP coverage.
- Help is available. If you have questions, you don’t have to figure this out alone. Contact your Medicaid plan administrator or the number on the back of your insurance card.
If you have a UnitedHealthcare Medicaid plan, you can visit uhc.com/staycovered. Assistance may also be available in multiple languages. What’s more, if you no longer qualify for coverage with Medicaid, other low- or no-cost options could be available; for example, with an Individual and Family plan found on the health care exchanges.
If I lose Medicaid coverage, what are my options for health insurance coverage?
Beneficiaries can explore coverage options on healthcare.gov. Most federally qualified health centers (FQHCs) also have navigators on staff to answer questions about coverage. UnitedHealthcare is also taking an active role to ensure individuals and families who no longer qualify for Medicaid are aware of and have access to affordable health care coverage. This includes UnitedHealthcare Individual and Family Plans, which you can visit at uhc.com/staycovered.
Will Medicaid members have to go through this process every year?
Prior to the COVID-19 pandemic and the PHE, Medicaid members had to enroll in the program each year to maintain eligibility.
For more information, visit uhc.com/staycovered.