Medicaid Eligibility: What to Know about the Current Changes

When a national public health emergency was declared at the onset of COVID-19, Medicaid made several changes to its enrollment and eligibility guidelines to provide much-needed health insurance for the public. The emergency ended this year which means many individuals who qualified for Medicaid during the pandemic may no longer meet the eligibility parameters. Up to 15 million Americans are at risk of losing their current Medicaid coverage, including senior adults and individuals living with disabilities. 

Many states have already started mailing out renewal forms to insurance holders in order to review their eligibility for Medicaid. At Direct Care Innovations, we understand that you work with clients who risk losing this essential health coverage. We want to make you aware of these changes, how they may affect your clients, and what they need to do to maintain or renew their Medicaid eligibility to receive insurance.

Update Contact Information & Return Completed Forms

It is imperative that each state’s Medicaid agency has the correct contact information for their beneficiaries. An incorrect address or phone number can delay the redetermination process, resulting in members losing their insurance coverage and not realizing it until their next doctor appointment or prescription pick-up. Encourage your clients to verify their contact information with their state of residence immediately.

Once insurance holders receive their eligibility forms in the mail, they need to complete and return them without delay. Most states offer a 30-day grace period for Medicaid members to return their applications. Some individuals, including adults living with developmental or intellectual disabilities, may need more time to complete their forms. If so, each state must provide a reasonable period of time for the forms to be completed and mailed to Medicaid.  

Forms Must Be Accessible to People Living with Disabilities

Federal law requires all Medicaid information to be accessible to individuals who have a limited understanding of the English language and adults who are living with a disability. At no cost to your clients, Medicaid agencies must provide requested assistance and services to help individuals clearly understand and complete the forms. These aids and services may include large print materials, sign language interpretation, auxiliary aids, and other similar assistance. 

Medicaid & Other Coverage Options May Be Available

While some of your clients may lose their Medicaid health coverage, others will remain eligible and be able to retain their insurance. Regardless of their eligibility for Medicaid, state agencies will check each individual’s application for eligibility across all categories of state health insurance. If they need more information to make an accurate determination, they will send renewal forms to those individuals.

If current healthcare members are no longer eligible, they can enroll in a healthcare plan through the Marketplace, provided by the Affordable Health Care Act. Most insurance holders will pay less than $10 monthly for coverage, and Medicaid will automatically send their information to the Marketplace. A special enrollment period will be open until July 31, 2024, so they can choose a new healthcare plan that suits their needs.

Appeals Can Be Made for Denied Medicaid Eligibility

If your clients have received a decision from the state that they disagree with, they can appeal that decision through a fair hearing. Included in each notice of termination is information about how to file an appeal. Typically, Medicaid members can keep their coverage while their eligibility is under review, but this decision is based on each individual appeal. Adults living with developmental disabilities can receive assistance from local legal aid organizations in filling out the appeal paperwork.

We Assist Caregiving Agencies Across the U.S.

At DCI, we make it our priority to help you efficiently manage your caregiving business so you can effectively and compassionately serve your clients. Our healthcare business management software makes your job easier with our healthcare training software, employee attendance software, electronic visit verification, and care management. Contact us at (480) 295-3307 or request a sales demo today.

Source: Gottlich, Vicki. “Public Health Emergency ‘Unwinding:’ Changes to Medicaid Enrollment and Eligibility.” Blog article. Administration for Community Living. U.S. Department of Health and Human Services, 22 Mar. 2023. Web. 31 May. 2023.