From the Providers Community: Frequently Asked Questions About Medicaid Renewals

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Losing Medicaid coverage? Don’t know if you’re still eligible? Don’t know where or how to renew your coverage?

Providers is here for you. Check out some of the most frequently asked questions we hear from Providers users about Medicaid renewals.

What’s happening?

States weren’t allowed to remove anyone from Medicaid during the pandemic. Then, in April 2023, states returned to normal eligibility processes. That meant that all Medicaid and CHIP (Children's Health Insurance Program) recipients had to start annual renewals again to see if they still qualified for coverage. The process of restarting eligibility checks, or redeterminations, has been commonly referred to as “Medicaid unwinding.”

Because of staffing shortages, lost mail, challenging paperwork, and outdated computer systems, millions of Americans have lost Medicaid by mistake. States have been working hard to fix these errors, but as of May 2024, more than one-quarter of people who received Medicaid and CHIP during the pandemic still haven’t been through eligibility checks, and another one-quarter have been disenrolled entirely. If you fall into either of these categories, here’s what you should know:

Top 10 FAQs About Medicaid Renewals from the Providers Community

1. Am I still eligible for Medicaid?

All states offer Medicaid to some low-income children, parents, pregnant individuals, seniors, and people with disabilities. States with expanded Medicaid programs cover other adults under a certain income level. If your income is below 138% of the federal poverty line and your state has expanded Medicaid coverage, you qualify for Medicaid based only on your income.

The following states have not expanded Medicaid and have different income eligibility limits: ​​Alabama, Florida, Georgia, Kansas, Mississippi, South Carolina, Tennessee, Texas, Wisconsin, and Wyoming.

Outside of those groups, each state will also have its own eligibility criteria. In some places you may automatically qualify for Medicaid if you receive benefits like SNAP or Social Security disability (SSI/SSDI).

Check your state health department website for guidelines. Your kids might still qualify for Medicaid even if you don’t.

2. Do I need to renew my Medicaid coverage? What if I’m disabled?

When states restarted eligibility checks after the pandemic policy ended, they were supposed to automatically renew coverage for certain groups, including individuals with disabilities. If this applies to you, you should have received a letter in the mail saying your coverage was renewed.

But due to staffing shortages and technical difficulties, these automated renewals haven’t gone to plan in many places. If you have questions about your Medicaid status or renewal date, call your local Medicaid office or log in to your state health department website.

If you received a renewal notice or paperwork in the mail, you should definitely complete and return it to your local Medicaid office by the due date listed in the forms—even if you receive disability benefits. If you don’t submit your renewal packet or verification documents in time, your Medicaid benefits will stop.

If you have children, fill this out even if you think you no longer qualify. Children are often still eligible for Medicaid even when the adults in your household are not.

3. When is my renewal due?

Everyone’s renewal date is different. The due date to submit your renewal documents should be listed in your packet, which is typically mailed out a month before your renewal is due, and in your state’s online portal.

States have to give you at least 30 days to submit and allow 90 days to reprocess your eligibility if you miss the deadline.

If you missed the deadline, you'll get a notice with your appeal rights and instructions. Contact your Medicaid office right away or within 90 days of losing coverage to resubmit your forms or request a fair hearing. If you don't respond within 90 days, you'll need to reapply for Medicaid.

If you were previously covered and still haven’t received a renewal packet in the last year, the best thing you can do is to make sure your contact information and address are up to date with your local Medicaid office. This is especially important if you’ve recently moved or got a new phone number because you don’t want to miss your renewal packet in the mail. Watch for mail, emails, and texts from your health department. They’ll let you know of actions needed for your benefits.

4. How do I renew my Medicaid coverage? Can I do it online?

Be on the lookout for your renewal paperwork in the mail, which should have submission instructions. States are required to accept completed forms online, via phone, in-person, or by mail.

5. What documents do I need to submit for renewal?

Along with your renewal packet, you will likely need at least one document from each section below, depending on your eligibility category

  • Income Verification: Check your state’s renewal form or web site for what specific income documents they might want from you.
  • Proof of Identity and Citizenship Status: Examples include your passport, driver’s license, birth certificate, green card, employment authorization card, and other relevant documents.
  • Proof of Pregnancy: This could be a statement from a doctor or medical professional with the expected date of delivery

Each state has different requirements, so look for instructions in your renewal packet or check with your local Medicaid office. In California, for example, citizenship or immigration status doesn’t matter for Medicaid eligibility.

It’s important to provide current and official documents, as well as documentation for all sources of income.

6. Will I receive a notice or letter for renewal?

Yes, all states are using mailers to reach Medicaid enrollees, but you will only get it if your state knows where you receive mail now — so make sure your mailing address is updated with your local office. Some states are also reaching out to people via text messaging, email, and phone calls.

7. Am I covered during the renewal process?

Yes, you should be covered while you wait for your renewal packet and from the time you receive the packet until it is processed.

If you were mistakenly disenrolled from Medicaid during Medicaid unwinding over the past year, you might be able to get retroactive coverage. This means that if you are determined eligible, your state may pay back medical bills you received during the coverage gap. Make sure to discuss this possibility with your case manager.

8. What if I didn’t receive a renewal form or letter?

Call your local Medicaid office or log in to your state health department website to check that your address and contact information are current, and to request a new renewal form be sent to you

9. Can I change my plan or healthcare provider during renewal?

If you are part of a Medicaid managed care organization, also known as a managed care plan or managed medical assistance, you should call your member services to understand your options, because you may be locked into your plan until the open enrollment period.

Otherwise, you should be able to switch to any provider that accepts Medicaid during your renewal, as long as you submit your paperwork by the due date to avoid a gap in coverage.

10. How do I check the status of my renewal? When will I find out if I am still eligible?

You can go to your state’s online portal to check on the processing status of your renewal. If you are found ineligible after your renewal is processed, you will be notified in the mail that your coverage is scheduled to end. You can appeal the decision if you believe this is a mistake. Appeal and fair hearing rights and instructions for filing an appeal will be on the notice.

Still have questions?

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