The COVID-19 pandemic created a public health emergency (PHE) in 2020, leading Congress to pass the Families First Coronavirus Response Act (FFCRA). Due to the FFCRA, state Medicaid agencies were not able to redetermine Medicaid beneficiaries’ eligibility, which ensured individuals maintained their health coverage during the pandemic.
As of April 1, 2023, state Medicaid agencies have resumed coverage terminations for those redetermined as ineligible. Each state has its own Medicaid program in which enrollees must annually qualify for health benefits. The renewal process is known as redetermination.
As of April 1, 2023, states can begin terminating coverage for ineligible individuals. Due to the reinstated redeterminations, the Kaiser Family Foundation estimates up to 14 million Americans may no longer be eligible for Medicaid.
There are several reasons an individual may lose coverage, including earning too much, failing to report a change in family status, ending a pregnancy, receiving an inheritance, or moving to a state with different Medicaid income requirements. An individual who is deemed ineligible can reapply through their state’s Medicaid agency or appeal the denial.
Additionally, an individual who loses coverage (a qualifying life event) can obtain health coverage through an employer-sponsored health plan, a plan offered through the ACA’s Marketplace, or Medicare (if 65 years of age or older). Those who lose Medicaid coverage will typically have 60 days, called the special enrollment period) to enroll in new coverage or will be forced to wait until the next annual enrollment period.
Individuals who believe they will lose Medicaid coverage can plan ahead by asking for more information on the available employer-sponsored plan. For help understanding employer benefit offerings, please contact the Creative Benefits ESR team.