Navigating the 2023 Medicaid Redetermination Process

In March 2020, significant changes were made to state Medicaid and child health insurance programs (CHIP) that would allow families to receive much-needed healthcare insurance during the COVID-19 pandemic. The Families First Coronavirus Response Act (FFCRA) authorized these temporary changes and required states that received federal health insurance funding to maintain continuous enrollment during the COVID-19 Public Health Emergency (PHE). Acumen Fiscal Agent has been working with state programs, managed care organizations, county programs, and veteran’s programs, helping them navigate these new changes during the pandemic.

Continuous Medicaid enrollment expired on March 31, 2023, along with the PHE, which ended on May 11. Many states have already begun the redetermination process for Medicaid enrollees, and all states have up to 12 months to complete this process and resume normal operations. As one of the largest undertakings in the history of the Medicaid program, the redetermination process will take place in two phases. At Acumen Fiscal Agent, we encourage all Medicaid recipients to be aware of the following steps to help them prepare for the Medicaid eligibility and renewal process.

Redetermination Process: Phase I

During Phase I, individual states are responsible for educating existing Medicaid enrollees about expected changes. They will be sending renewal letters to individuals who are currently receiving Medicaid insurance. The three action steps below can make this phase simpler and less complicated: 

1. Update contact information: Call the state Medicaid office to ensure they have the Medicaid enrollee’s current mailing address, phone number, and email.
2. Check mail or email: A letter or email will be sent to each current Medicaid enrollee, letting them know if they need to complete a renewal form or if their health insurance has been terminated.
3. Complete the renewal form: If individual’s receive a renewal form, they must complete it and return it immediately to their state’s Medicaid office.

Redetermination Process: Phase II

In Phase II, individuals will be notified if they are still eligible to receive Medicaid or CHIP or no longer qualify for state-funded healthcare. Your clients have three options to choose from if they are no longer eligible: 

Health Insurance Marketplace Plans

Losing Medicaid or CHIP coverage due to redetermination is a Qualifying Life Event, allowing them to enroll in a Marketplace plan outside the regular Open Enrollment Period. Many of these affordable plans cost less than $10 a month for eligible individuals. They cover many medical costs including prescriptions, doctor visits, urgent care or emergency visits, hospital stays, etc. If individuals no longer qualify for Medicaid but still have Medicare, they will not need to enroll in a Marketplace health plan.

Children’s Health Insurance Programs (CHIP)

Children with Medicaid coverage terminated may be eligible for health insurance through their state’s Children’s Health Insurance Program or CHIP. You can visit your state’s Medicaid website or the Medicaid.gov website to learn more.

Medicaid Health Plan Appeals

If one of your clients or patients disagrees with the denial of Medicare due to their ineligibility, they can appeal that decision. On their denial letter, there should be directions for how to begin the appeal process. They can also contact their state’s Medicaid office for assistance or visit the Medicaid.gov website.

National Company with a Local Presence

At Acumen Fiscal Agent, we strive to simplify life for veterans, aging adults, and individuals with physical, intellectual, and developmental disabilities by providing fiscal management services across the country that have a positive and long-lasting impact on their lives. Contact us at (877) 211-3738 to learn more about our self-direction programs and fiscal management services.

Source: “Unwinding and Returning to Regular Operations after COVID-19.” Web article. Medicaid.gov. Centers for Medicare & Medicaid Services. Web. 06 Jun. 2023.