What is Medicaid Redetermination?

Whether you have heard of Medicaid Redetermination, Medicaid Recertification, Medicaid Renewal, or Medicaid Unwinding, they all mean the same thing: the process by which states determine if beneficiaries still qualify for Medicaid or Children’s Health Insurance Program (CHIP) coverage.

During Medicaid Redetermination, officials ask beneficiaries to show that they meet the financial requirements and other criteria for Medicaid eligibility. The redetermination process varies by state, Medicaid program, and eligibility groups.

How COVID-19 Affected Medicaid Redetermination

Normally, Medicaid Redetermination occurs annually or every 12 months. Beneficiaries had to complete renewals by their state’s deadline to maintain benefits. However, after the COVID-19 pandemic, most beneficiaries, including those enrolled in Medicaid or CHIP coverage and those who became eligible during the pandemic, received exemptions from completing redeterminations.

The continuous Medicaid coverage has since ended in Medicaid unwinding. States resumed normal Medicaid operations on March 31, 2023. As of September 12, 2024, since states restarted eligibility renewals and coverage terminations, 25.2 million people have been dis-enrolled.

What to Do if You Lost Medicaid Coverage

If your Medicaid coverage continued because of the public health emergency, you may have lost coverage or will need to take action to verify your eligibility. Also, note that states are restarting Medicaid Redetermination on different dates; in other words, the previous redetermination date might not be the same as the new one, so be sure to check with your Medicaid Agent before your annual review.

Thankfully, you can appeal the decision if you receive a notice that your coverage ended. You can also apply for other coverage options, through the Affordable Care Act (ACA) Marketplace health insurance, an employer plan, or Medicare. The ACA offers financial assistance to individuals and families and helped states expand Medicaid to adults with household incomes up to 138% of the federal poverty level. Note, losing Medicaid coverage can be a qualifying life event (QLE), thus making you eligible for a Special Enrollment Period (SEP).

If you have Medicaid, double-check that your contact information is up-to-date with the Medicaid department for your state. Keep an eye out for mail about your Medicaid coverage and reply as soon as possible if they request information.

How to Qualify for Medicaid and CHIP

Medicaid and CHIP are available for families, children, pregnant women, older people, and people with disabilities. Medicaid programs help you pay for medical care; CHIP provides low-cost health coverage to children, even for families that earn too much to qualify for Medicaid.

There are two ways to apply for Medicaid and CHIP:

Fill out an application through the Marketplace—a state agent will then contact you.

Apply directly through your state’s Medicaid Agency.

To qualify for both Medicaid and CHIP, you must show that your income level is below a certain threshold. Income eligibility varies depending on the state you live in; however, in most states, income qualifications are determined by the size of the household. Some individuals are exempt from income counting rules, such as those whose eligibility is based on disability or age (65 and older). For additional information, visit Medicaid.gov.