Updated 2/16/23
Summary:
- States have different eligibility requirements, services, and insurance plans for both Medicaid and CHIP. Some states use different names for their Medicaid and CHIP programs. So, it might not be obvious to you that your health insurance program is a Medicaid or CHIP program.
- Medicaid and the Children’s Health Insurance Program (CHIP) are state-administered health coverage programs funded by the Federal Government and the states.
- Since March 2020, Medicaid has not conducted eligibility reviews of existing Medicaid and CHIP enrollees. Starting on February 1, 2023, eligibility reviews will resume. Terminations of coverage could happen as early as April 1, 2023.
- Between 5-14 million people with Medicaid or CHIP could be disenrolled from those programs.[1] However, they may be eligible to buy a health plan through the Health Insurance Marketplace ®, and get help paying for it.
- Because each state has different eligibility requirements, different services, and different insurance plans for their Medicaid and CHIP programs, you will need to contact your state’s Medicaid or CHIP office or local “assistors” to take action to protect your insurance coverage.
- The termination of “continuous enrollment” and the resumption of eligibility reviews is also called the redetermination process or “Medicaid Unwinding.”
Steps to Take Now
3. Gather Financial Information You May Need For a Medicaid Eligibility Review
What to Watch For:
5. Check your post office mail for a letter from Medicaid and act on it by the due date.
6. Where to go for Help in your state or Territory
7. What happens if Medicaid terminates my coverage?
Why Are Eligibility Reviews for Medicaid and CHIP Enrollees Resuming?
Frequently Asked Questions
Steps to Take Now: 1. Find out if you and your family get Medicaid or CHIP, and if you might be affected.
Do you or a family member currently have health coverage through Medicaid or the Children’s Health Insurance Program (CHIP)? Many states use different names for their Medicaid program and CHIP programs. See some examples in the table below.
|
Example State |
Medicaid Program Name |
CHIP Program Name |
|
Arizona |
Arizona Health Care Cost Containment System (AHCCS) |
AHCCCS-KidsCare |
|
California |
Medi-Cal |
Medi-Cal |
|
Florida |
Florida Medicaid |
Florida KidCare |
|
Maine |
MaineCare |
CubCare |
|
Massachusetts |
MassHealth |
MassHealth |
|
Washington |
Apple Health |
Apple Health for Kids |
As a result, you may not be aware that your health insurance plan is a Medicaid or a CHIP plan.
If you or your family are enrolled in a Medicaid or CHIP plan, be aware that Medicaid and CHIP will resume eligibility reviews for enrollees as early as February 1, 2023. This means some people with Medicaid or CHIP could be disenrolled from those programs. However, they may be eligible to buy a health plan through the Health Insurance Marketplace ®, and get help paying for it. Because each state has different eligibility requirements, different services, and different insurance plans for their Medicaid and CHIP programs, you will need to contact your state’s Medicaid or CHIP office to take action.
Steps to Take Now: 2. If you do get Medicaid or CHIP, contact your Local Medicaid or CHIP office and Update your Contact Information
If you or a family member are receiving Medicaid, you should prepare for a Medicaid renewal or redetermination updating your contact information.
- Make sure the Medicaid or CHIP Program in your state has your current mailing address, phone number, email, and other contact information. This way, they’ll be able to contact you about your Medicaid or CHIP coverage.
- Click here to find the Medicaid Program in your State and update your contact information. This is critically important if you have moved in the past year or two and have not updated your contact information!
- You can also go here and use the drop down menu on the right side of the screen to select your state.
Steps to Take Now: 3. Gather Financial Information You May Need for a Medicaid Eligibility Review
Medicaid Eligibility requirements vary by state and the pathways used to apply for Medicaid or CHIP programs. For example, one pathway is to apply to Medicaid directly. Another pathway is to apply for Medicaid through a Marketplace plan, and another common pathway is to apply to Social Security for Supplemental Security Income (SSI).
The required documentation needed for eligibility will vary significantly, but you should at least collect the following resources:
Non Financial Resources
- Proof of residency in the state where you are currently receiving Medicaid
- Proof of US Citizenships or certain qualified non-citizens
Financial Resources
- Checking and Savings Accounts in your Name Only or Joint Accounts with your Name
- Any Investments or Countable Resources Held in your Name
- Any Trusts Held in your Name or For your Benefit
- Tax Documents
Steps to Take Now: 4. If you get Medicaid because you get Supplemental Security Income (SSI) through Social Security, make sure that your SSI eligibility is in order
Make Sure Social Security Has your Most Current Contact Information
If you or a family member is eligible for Medicaid because they are eligible for Supplemental Security Income (SSI) from Social Security, make sure that the Social Security Administration (SSA) has your current mailing address, phone number, email, and other contact information.
- Set up a personal My Social Security Account Online You can change your address and contact information in the My Profile Tab in your My Social Security Account.
- If you get SSI, do not have a U.S. mailing address, or are unable to change your contact information online, you can call Social Security at 1-800-772-1213 (TTY 1-800-325-0778), Monday through Friday, 8:00 a.m. – 7:00 p.m. or contact your local Social Security office.
States where SSI Eligibility Makes You Categorically Eligible For Medicaid
Maintaining SSI eligibility is especially important in those states listed in the first two rows of Table 1. In these states being eligible for SSI means that you are also categorically eligible for Medicaid. As long as you are eligible for SSI you should still be eligible for Medicaid.
Table 2: States Where Being Eligible for SSI Makes You Categorically Eligible for Medicaid
|
Policy Regime |
Enrollment Process |
SSI Eligibility |
States |
|
Automatic Enrollment |
Social Security Administration (SSA) automatically notifies state Medicaid office upon determining that an SSI applicant is eligible for SSI. |
Confers categorical eligibility for Medicaid. |
Alabama, Arizona, Arkansas, California, Colorado, Delaware, District of Columbia, Florida, Georgia, Iowa, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Mississippi, Montana, New Jersey, New Mexico, New York, North Carolina, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Vermont, Washington, West Virginia, Wisconsin, and Wyoming. (Sometimes called the “1634” states.) |
|
Separate Application Non-Restrictive |
SSI applicant must file a separate Medicaid application |
Confers categorical eligibility for Medicaid. |
Alaska, Idaho, Kansas, Nebraska, Nevada, Oregon, and Utah. (Sometimes called the “SSI Criteria states”) |
|
Separate Application Restrictive |
SSI applicant must file a separate Medicaid application |
Does not confer categorical eligibility for Medicaid. State uses at least one eligibility criterion that is more restrictive than those of SSI. |
Connecticut, Hawaii, Illinois, Indiana, Minnesota, Missouri, New Hampshire, North Dakota, Ohio, Oklahoma, and Virginia. (Sometimes called the “209b states.”) Regardless of policy regime, SSI applicants who are not categorically eligible for SSI may yet be Medicaid-eligible depending on state eligibility rules. |
Important:
- Make sure that Social Security has an accurate accounting of your wages. Don’t assume they collect this from your employers’ payroll data. Use Social Security’s online wage reporting tools to upload your paystubs. Another option is to make a copy of your pay stubs. Keep the copy. Mail the originals to your local Social Security office using “Return Receipt.” Retain the “Return Receipt” for your records along with the copy of the pay stubs.
- If you are working and are receiving SSI, be aware that you may continue to receive cash benefits payments until your countable income exhausts your SSI cash benefit. Your SSI cash benefits are based on how much non SSI income you have. much other income you have. When your other income goes up, your SSI payments usually go down. (See Working While Disabled: How can we help?)
- However, even if you have exhausted your SSI cash benefits, your Medicaid coverage would be handled through the 1619(b) program, until you earn more than state 1619(b) income threshold. Click here to find the 1619(b) program requirements and income thresholds for your state.
- If you do exceed your state’s 1619(b) Medicaid income threshold, check to see if your state offers a Medicaid Buy-In program.
- Your allowable Countable Resources for SSI can’t exceed $2000.
- Social Security – Spotlights on Income re: SSI
If you get SSI and Medicaid, make sure you continue to qualify for SSI, as it will make it a lot easier to go through this Medicaid redetermination process! If you need additional help understanding SSI eligibility requirements, watch Free AANE Webinar: 2023: How to Find Public Benefits for Autistic Adults in any State.
What to Watch For: 5 Check your mail for a letter from Medicaid and act on it by the due date.
- Check your mail – your state Medicaid Program will mail you a letter about your Medicaid or CHIP coverage. This letter will also let you know if you need to complete a renewal form to see if you still qualify for Medicaid or CHIP. Open it right away and read it. If it doesn’t make sense to you:
- Contact a trained “assistor” in your local area. Click here to find a list of “assistors” or go to https://localhelp.healthcare.gov/
- Complete your renewal form right away (if you get one). Fill out the renewal form and return it to your State Medicaid program right away to help avoid a gap in your Medicaid or CHIP coverage. If you need help, use the resources listed above.
- When will you hear from Medicaid?
- Every state has its own unwinding process. Redeterminations can’t be started earlier than February 1, 2023. Enrollees can’t be terminated before April 1, 2023. And all enrollees should undergo redetermination within 14 months (by August 2024).
- You could receive email or letters from Medicaid as early as February 1, 2023, telling you that Medicaid has started the redetermination process for you.
- But, some of you may never be contacted at all by Medicaid, because they are first going to try to use the information they currently already have to determine if you remain eligible for Medicaid.
- Using information from other existing sources is called Ex Parte Renewal.[3] Other terms for Ex Parte Renewal are auto-renewal, passive renewal, or administrative renewal. The most common sources for Ex Parte data are likely to be SNAP (food stamps) and Social Security SSI data.
- You can try to get more clarity on your situation, by contacting your state Medicaid or CHIP office to see if and when they might begin the redetermination process for you. They may not be able to tell you either.
- If you receive a termination letter from Medicaid, file a response by the due date, and contact a trained “assistor” in your local area.
- Note that losing Medicaid or CHIP coverage is a Qualifying Life Event (QLE), which allows you to enroll in a Marketplace plan outside of the Open Enrollment Period.
- Because Medicaid eligibility requirements are so different state to state AANE will not be in the best position to help you with eligibility termination questions, filing an appeal, finding local legal or advocacy resources or finding alternative health plan coverage. Local assistors and local Medicaid/CHIP offices are better able to help in those areas.
What to Watch for: 6. Where to go for Help in your State or Territory
Medicaid & Partner Resources
- Another List of Medicaid Program Names by State along with who to Contact
- List of Medicaid State Agencies (See the Contact your State Medicaid Agency Drop Down Box on the right side)
- Medicaid & CHIP – State Agencies & Redetermination/Renewal
- HealthCare.gov or call the Marketplace Call Center at 1-800-318-2596 to get details about Marketplace coverage. TTY users can call 1-855-889-4325.
- https://localhelp.healthcare.gov/
- https://www.healthcare.gov/find-assistance/
Other Resources
- The ARC – there are over 600 local Chapters of the ARC, and some of them are quite active in supporting individuals with DD and IDD during the Medicaid unwinding process.
- Your Local Center for Independent Living may also be able to assist you
- Also contact your local affiliate of the Autism Society
What to Watch For 7. What happens if Medicaid terminates my eligibility?
There will be an option to appeal, so make sure you file the appeal on a timely basis. If you require legal assistance, look for resources from the National Disability Rights Network’s (NDRN) Directory.
If you or a family member was receiving Medicaid HCBS Waiver services, contact your case manager at your state agency for Developmental Disabilities or reach out to the local chapter of the ARC.
If you do end up losing your Medicaid coverage, you shouldn’t lose health insurance coverage completely.
- Losing Medicaid coverage is a Qualifying Life Event (QLE) that allows you to enroll in a Marketplace plan. In addition, on January 30, 2023, the Center for Medicaid Services (CMS) announced that there will be a special enrollment period from March 31, 2023 to July 31, 2024. In order to be eligible for the special enrollment period, individuals must be eligible for Affordable Care Act marketplace coverage and must have lost their Medicaid, Children’s Health Insurance Program (CHIP), or Basic Health Program (BHP) coverage.[4]
- Medicaid has emphasized that Marketplace plans are now
- More Affordable. 4 out of 5 enrollees can find plans that cost less than $10 a month.
- More Comprehensive. Most plans cover things like prescription drugs, doctor visits, urgent care, hospital visits
- And that the number of Assistors and Navigators has increased.
- Contact local resources in your state to find help:
Why Are Eligibility Reviews for Medicaid and CHIP Enrollees Resuming?
Since March 18, 2020, Medicaid has not been able to terminate Medicaid enrollees due to the passage of the Families First Coronavirus Response Act (FFCRA).[2] This freeze on terminating Medicaid enrollees is often referred to as “continuous enrollment.”
An additional 20 million people have enrolled in Medicaid and CHIP since March 2020, bringing the total number of enrollees to 91 million enrollees as of September 2022. This represents approximately 27% of the US population.
On December 29, 2022, the Consolidated Appropriations Act, 2023 (CAA, 2023) was enacted. This act removes the freeze on Medicaid eligibility re-evaluations (also called redeterminations), and will cause the following to happen:
- Starting February 1, 2023, states can resume Medicaid and CHIP eligibility reviews that they temporarily stopped during the pandemic. When states resume these reviews, millions of people could lose their current Medicaid or CHIP coverage.
- States must begin the Medicaid re-evaluation/redetermination process by April 1, 2023
- States cannot terminate coverage for any Medicaid enrollees before April 1, 2023
- States must complete Medicaid eligibility re-evaluations/redeterminations within 14 months.
Frequently Asked Questions
Q: Will Medicaid accept new applications during the redetermination period?
A: As far as we know, yes.
Q: If Medicaid does an Ex Parte Renewal and determines that I’m not eligible for Medicaid, will I have a chance to respond and correct that information?
A: Yes. An Ex Parte Renewal You should be sent the information and be given the chance to correct the erroneous information, which is why it is essential for Medicaid to have your correct contact information.
Q: Will all Medicaid enrollees be re-evaluated, including those who get Medicaid because the get SSI?
A: As far as we can tell, all 91 million enrollees are subject to the redetermination process. Even if you get SSI, you will still be re-evaluated by Medicaid. That may mean that Medicaid simply looks at Social Security data to see if you get SSI. (See Ex Parte renewal above.)
Q: Even if I’m eligible after redetermination could I end up with a new Medicaid plan?
A: Yes, that could happen, depending on your income and assets and other factors. This is very dependent on the pathway you took to enroll in Medicaid, eligibility requirements and MAGI (financial requirements) in your state, and available plans in your state. So talk to a trained Assistor if you have questions.
Q: If I get SSDI (but not SSI) and I have a Medicaid plan, will my Medicaid redetermination be subject to SSI eligibility requirements for Medicaid?
A. If you are not currently receiving SSI, your Medicaid redetermination will be subject to the state’s eligibility requirements for your current Medicaid plan and pathway.
Q: I get SSI but I haven’t been re-evaluated by Social Security for many years. Will that be a problem during this Medication redetermination process?
A:
-
- Depending on the nature of the beneficiary’s disability, Social Security is supposed to do a medical Continuing Disability Review (CDR) every 3-7 years.[5] However, Social Security is facing an unprecedented backlog of CDRs[6] – So you may not have been re-evaluate in a very long time. Nevertheless, you should always be prepared. You should maintain a relationship with medical providers, including behavioral health providers if appropriate, so they can provide “treater reports” to Social Security, in case Social Security suddenly decides it’s time for your CDR.
- Social Security is also supposed to review a beneficiary’s financial eligibility for SSI every 1 to 7 years. This is called SSI Redetermination.
- So Social Security’s timelines for redetermination lag way behind Medicaid’s Unwinding Redetermination timelines. Whether or not this is a problem is a gray area. In states where SSI eligibility automatically confers categorical Medicaid eligibility, we hope that there are fewer problems.
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