How the End of Medicaid Continuous Enrollment Could Affect You
As of November 2022, nearly 92 million people were enrolled in Medicaid and CHIP, the highest number on record and a nearly 30% increase over February 2020 enrollment numbers. This is largely thanks to the fact that, during the COVID-19 Public Health Emergency (PHE), state Medicaid agencies could get extra federal reimbursement money as long as they didn’t terminate anyone’s coverage. But this requirement is ending on April 1, and it could result in millions of people losing their health insurance.
The practice of not terminating coverage is officially called “continuous enrollment,” and it prevented people from losing their insurance during the pandemic for the usual (aka, income-related) reasons. For many people who lost their jobs during the pandemic and subsequently got on Medicaid, that meant they would remain covered unless they moved out of state or voluntarily ended their coverage—even if they started making more money than the eligibility rules allow. In general, state Medicaid agencies responded to the continuous enrollment requirement by pausing their review, renewal, and termination processes altogether.
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All of that is about to come to an end. The COVID-19 PHE officially ends on May 11, but Congress’ spending bill for 2023 allows states to start phasing out continuous enrollment about six weeks earlier, on April 1. With more than three years of reviews to work through—during which time agencies saw their highest-ever enrollment numbers—this is clearly going to take some time. To help spread out the workload, Medicaid agencies have 12 months to initiate renewals and 14 months to complete them.
So, what does this mean for the roughly 92 million people currently insured through Medicaid? It all depends on which state you live in and how they’re handling this “unwinding” process. Medicaid eligibility is usually reviewed every year, but with so much COVID backlog to work through and a minimum 12-14 month unwinding period on the table, the timeframe is a little longer than usual. Here’s what to keep in mind as continuous enrollment comes to an end.
The first step is to not panic. You don’t have to do anything, really—your only responsibilities are to be aware of the timeline and be prepared to verify your income. If your income hasn’t changed since you applied and the state can verify it electronically, you’ll get a new notice of eligibility in the mail and that will be that; you’ll be set for another year. If they can’t, you’ll get a notice in the mail with a formal request for information. Generally, they’re required to notify you at least 60 days before the renewal date, and you’ll have 30 days to reply with additional information. (And if you wouldn’t currently qualify, don’t panic just yet—some states are creating “bridge programs” to cover people who wouldn’t qualify.)
But the nasty little secret about Medicaid terminations is that they don’t always happen for eligibility reasons. Lots of eligible people lose their benefits every year to “churn,” which is when documents get lost in the mail or returned to sender, phone lines take too long to get through, and administrative red tape generally prevents people from communicating with the state. To ensure this doesn’t happen to you, make sure you don’t miss important communications:
Watch your mail: The most important notices will come by mail, so keep an eye out. (And if you’ve moved, check to ensure your state agency has the correct address.)
Leave room in your voicemail inbox: You don’t have to start taking calls from unknown numbers—just make sure the important ones can leave you a message.
Watch for texts: Many states are adding text messaging to their communication options to speed things up during the unwinding period, so if you’re someone who ignores texts from unfamiliar numbers, at least skim them to see if there’s any Medicaid communications in there.
Check your spam folder: Unfortunately, government agencies don’t always know how to keep their email blasts from getting caught by spam filters.
The bottom line: If you or someone in your household got on Medicaid or CHIP during the pandemic, expect to re-verify your eligibility sometime between April 1, 2023 and April 1, 2024. You only have to worry about losing coverage if your circumstances have changed since you applied and your current income is above the Medicaid maximum. Even if it hasn’t, be ready to verify your income just in case. No news is good news; your coverage can’t be terminated without notice.
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