How to avoid getting dropped from Medicaid as states narrow coverage

Personal finance

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As a pandemic-era policy winds down, millions of people on Medicaid may lose their coverage — even though they remain eligible, advocates say.

For the last three years, due to the Families First Coronavirus Response Act, states have been required to provide continuous Medicaid coverage to enrollees in order to get federal funding. That meant people on Medicaid couldn’t be dropped from the program during that time.

“From March 2020 to March 2023, people could only enter Medicaid, and no one was at risk of losing coverage,” said Kosali Simon, professor of health economics at the O’Neill School at Indiana University.

Starting this month, however, states are resuming the usual eligibility redetermination process, which may lead to difficulties for millions of Americans, many of whom are already in a vulnerable position.

“The Medicaid population is disproportionately low income, with chronic or debilitating conditions,  and they also frequently move residences or do not speak English as their primary language,” said Caitlin Donovan, a spokesperson for the National Patient Advocate Foundation.

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The expiration of the so-called continuous coverage provision could result in as many as 14 million people losing their Medicaid coverage, according to the Kaiser Family Foundation. Nearly 7 million people may be dropped from their plans even though they still qualify.

“The states may not have the correct contact information for them, or even if they do, [enrollees] may not realize what the forms are when they receive them in the mail,” Donovan said.

Here’s how to avoid losing your Medicaid coverage if you believe you remain eligible.

Be on the lookout for notices about coverage

In the following months, states are likely to reach out to Medicaid beneficiaries in multiple ways, Donovan said.

“People should always check their mail for notices from their state Medicaid agency, but they can also check email, texts, phone calls or even e-portals where they may manage their care,” she said.

You’ll want to quickly provide any information your state agency requests from you, Donovan said: “It may keep you enrolled.”

Some of the notices states are sending to people are confusing, Donovan said.

For example, she said one state told someone that they no longer qualified for Medicaid but then said their eligibility was still being determined. This is why communication with your agency and making sure they have the latest information for you will be crucial, she said.

“This is going to be a confusing process for a lot of people,” Donovan said. “If you receive notice, don’t give up hope.”

You can appeal if you’re dropped, find new coverage

Your state should provide you with information on how to appeal your coverage decision, should they deem you ineligible, Donovan said. That process should unfold within a certain timeframe to avoid too long of a gap in your coverage.

Anyone who loses their appeal for Medicaid coverage could look for insurance on the public exchange, Donovan said, where a special enrollment period is open through July.

“The marketplace has subsidies in place so you should be able to find a zero monthly premium plan and may even qualify for out-of-pocket assistance as well,” she said.

In some states, former Medicaid enrollees may actually be automatically transferred to a marketplace program, Donovan said: “Every state is different.”

Donovan is especially concerned that millions of children will become uninsured over the following months.

Parents who are dropped from Medicaid shouldn’t assume that their children no longer qualify either, she said. Children can be eligible for Medicaid or the Children’s Health Insurance Program at higher income levels than adults.

“Basically, double-check everything,” Donovan said.

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