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Understanding Medicaid Redetermination Process

What is Medicaid redetermination?

Posted on April 7, 2023 by Larry Johnson

Are you concerned about losing healthcare coverage as a result of possible changes to Medicaid? Call (800) 950-0608 today to speak with one of our licensed agents about Medicare plan options that can help you get the care you need.

Major Medicaid Changes Are On the Horizon

While Medicare is the primary form of health insurance used by senior citizens, it’s not the only one. Many seniors and Medicare navigators are also enrolled in private insurance options, or they’re an enrollee in Medicaid via the affordable care act.

Seniors on low fixed incomes who cannot rely on Medicare alone often become an enrollee in both Medicare and Medicaid programs to cover their healthcare costs. These seniors, who are considered “dually eligible”, have been content to breathe a sigh of relief with the knowledge that they’ll have some form of coverage should serious health issues arise. 

However, the public health emergency (PHE) declaration surrounding COVID-19 coming to an end has forced certain Medicaid program changes, primarily geared toward new enrollments and continuous enrollment.

If you’re a senior with dual eligibility, you may wonder what these changes have to do with Medicaid. As we’ve recently discovered, changes having to do with Medicaid may have serious implications for dual eligible seniors who have been able to stay on the Medicaid program via the continuous enrollment provision, up to and possibly including disenrollment.

Is the Medicaid continuous enrollment provision changing?

Medicare and Medicaid: What’s the Difference?

Medicare and Medicaid are both federal programs that provide health insurance for senior citizens and disabled individuals. However, that’s where the similarities between the two programs end, for the most part.

Medicare is a program run by the federal government that provides affordable healthcare for senior citizens 65 and older, as well as citizens who qualify as a result of disability or illness. Individuals can choose to become an enrollee in what is known as Original Medicare, which is made up of hospital insurance (Medicare Part A) and medical insurance (Medicare Part B) and provided entirely by the federal government. 

Eligible individuals also have the choice to become an enrollee in private Medicare plans, such as Medicare Advantage (Part C), Prescription Drug coverage (Part D), or Supplemental Insurance (Medigap). The federal government does not offer these private plans, but they authorize private health insurance companies to do so instead.

Medicaid is a cooperative effort managed by the federal governments and governments at the state level. Eligibility for Medicaid does not open up to all at a certain age, and is restricted to enrollment due to the following special circumstances:

  • A low household income
  • Pregnancy
  • The onset of certain disabilities or illnesses

The primary difference between Medicare and Medicaid lies in the enrollment process. When you become an enrollee in Medicare, you’re typically a beneficiary of your plan throughout the rest of your life. Unless you decide to change your plan, or switch between plans, you remain enrolled in your chosen Medicare plan for the duration with no lapse in coverage. 

Medicaid regulations require beneficiaries to go through what is known as Medicaid redetermination. This means that, in order to avoid disenrollment in Medicaid, one must prove to their state that they still qualify for Medicaid insurance.

I’m on Medicaid, and Was Told I Wouldn’t Have to Qualify Again - What Gives?

When the COVID-19 pandemic first hit, Congress enacted a law that required Medicaid to allow continuous enrollment for people who were enrolled in the program. This law, known as the Families First Coronavirus Response Act (FFCRA), put a continuous enrollment provision in place to ensure that low-income individuals and those who were especially sensitive to the COVID-19 virus would not have to fear losing health care coverage due to disenrollment.

However, thanks to the signing of the Consolidated Appropriations Act on December 29, Medicaid continuous enrollment is coming to an end. As the public health emergency (PHE) for COVID-19 has been lifted, so has the continuous enrollment provision. This provision ended on March 31, and could lead to numerous Medicaid enrollees losing their health care coverage and experiencing disenrollment.

As a result of the COVID-19 pandemic, the Medicaid program saw a large uptick of enrollments for a variety of reasons. The primary reason for the boost in Medicaid enrollment? Americans who lost their jobs as a result of the pandemic found themselves in need of quality healthcare coverage, and as they now met the income threshold to obtain Medicaid benefits, they chose to become an enrollee in the program. 

When the FFCRA changed Medicaid regulations to allow for continuous enrollment, many of these beneficiaries retained their policies to get access to healthcare at manageable costs, even if they no longer fell within qualification parameters.

It is stated that nearly 100 million citizens were covered by Medicaid as of November of 2022. Per the Medicaid changes set forth in the CAA, this number will drop considerably as eligibility redetermination begins this month.

New Medicaid redetermination rules for seniors

I’m a Senior Citizen Who Relied on Medicaid, What Are My Options?

If you’re a senior citizen set to lose your Medicaid coverage as a result of the repeal of the continuous enrollment provision, things may look bleak. However, finding quality healthcare coverage that meets your needs is just a phone call away.

Our friendly, knowledgeable licensed agents can utilize your contact information to help you find Medicare plans in your area that provide the coverage you need most. Give us a call today at (800) 950-0608 to speak with a licensed insurance agent regarding Medicare plan options in your area.

About the Author

Larry Johnson

Larry is a content writer with several years of experience in creating informative content for a variety of industries on topics that matter. He is a 2009 graduate of the University of North Carolina School of the Arts.

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