What to do if you’re losing Medicaid coverage

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Millions of current Medicaid recipients are poised to lose health insurance coverage as states begin to disenroll recipients who qualified for coverage during enhanced funding and expanded eligibility under provisions of a public health emergency declared during the Covid pandemic.

But many people who are losing their eligibility can avoid coverage gaps by enrolling in insurance programs offered via state health insurance exchanges and exploring other insurance options via private insurers.

In addition, adults who are losing their coverage need to be aware that their dependent children might still be eligible for Medicaid coverage, the federal Children’s Health Insurance Program (CHIP) or other state and federal insurance programs.

Steps to take if you lose Medicaid coverage

At the beginning of the Covid-19 pandemic, the U.S. Congress created legislation that allowed people on Medicaid to keep their coverage through the health emergency, according to health-policy research firm KFF, which was formerly called the Kaiser Family Foundation. But that grace period ended on March 31, 2023.

State Medicaid programs are now conducting “redetermination” processes – reviewing the qualifications of those receiving benefits and disenrolling those who no longer qualify. Between 5 million and 14 million people could lose their coverage, according to KFF.

How will you know if you’re losing Medicaid coverage? The states are required by law to inform individuals by mail if they are no longer eligible for Medicaid insurance because of income level or other reasons. Those reasons must be spelled out in the letter. And the states must also outline steps recipients can take to sign up for health insurance via the state-run health insurance exchange, says Allie Gardner, from Georgetown University’s McCourt School of Public Policy. Gardner is a senior research associate in the school’s Center for Children and Families.

While states operate their own marketplaces, individuals can go to health.gov to access the exchanges. A special enrollment period enables individuals to check eligibility for private insurance and CHIP coverage and apply and enroll in a plan. The health plans are divided into “metal” levels, such as platinum and bronze, that differ in how much individuals pay for premiums and out-of-pocket costs.

Individuals who are self-employed may be able to reduce the costs of insurance coverage via an exchange by deducting the costs of health insurance. More information on deductions can be found here. In addition, there are alternatives to Medicaid: The Affordable Care Act provides tax credits and subsidies for insurance companies to offer coverage for people making up to 400% of the federal poverty line. Click here for information on Medicaid alternatives.

On the health.gov site, you can enter your ZIP code and click the “find local help” link to connect with a healthcare navigator, who is trained to assist individuals in understanding what health plans are available to them in the exchange. Health navigators also are trained to find help with scheduling appointments, transportation and financial, legal and social support.

The state is required to transfer an individual’s Medicaid account information to the state health exchange to expedite enrollment in subsidized insurance, Gardner says. But the process has not always been smooth, she adds. “The states are required to transfer the Medicaid information to the health insurance exchanges, but their obligation ends there,” she says.

Will children lose Medicaid coverage?

Gardner says the disenrollment process is also creating confusion for parents about the health insurance for their children. Parents need to be aware that even if they lose Medicaid coverage, their children often will still qualify for insurance.

“Eligibility requirements for children are much more expansive than for adults, so parents should contact Medicaid and find out how to ensure their children can continue to be insured,” she says. “Right now, the onus is on parents to do it, states are not required to inform them.

“Federal agencies and several states are working on including that messaging to recipients about their children’s coverage, but we’re not aware of anyone doing it.”

Parents also can access the federal site InsureKidsNow.gov to learn about and apply for Medicaid and CHIP programs in their state or call 1-877-KIDS-NOW (1-877-543-7669) for assistance.

What to do if you’re losing Medicaid coverage

Steps to take if you lose Medicaid coverage

Will children lose Medicaid coverage?

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