By Andrew Hetzler, CEO
Beginning April 1, 2023, states will be able to terminate Medicaid coverage for individuals who are no longer eligible. Many consumers who lose Medicaid coverage will be directed to apply for coverage through the Affordable Care Act (ACA) marketplace.
To keep people in coverage during the COVID-19 Public Health Emergency (PHE), states paused terminations for Medicaid coverage as of March 2020. But effective April 1st, each State Medicaid program will resume regular eligibility and enrollment operations, including renewals and coverage terminations, a process commonly referred to as “Unwinding.”
Some states began this redetermination process as early as February 1, with the first terminations effective on April 1, 2023. However, not all States are going to rush to terminate coverage for members that are no longer eligible.
Who will get kicked off of Medicaid first? Most likely those who were under the age of 19 at the time of CHIP enrollment (the version of Medicaid coverage that covers children of lower income families), but who are 19 or older as of 2023. No one is eligible for CHIP once they turn 19, so that’s an easy one.
The more complex terminations will be for adults, since most State Medicaid programs have complex income determinations for applicant eligibility, which can sometimes include household income as well as the value of assets like cars and homes. Those redeterminations may take more time to sort through.
Either way, people will have 60 days before and 60 days after a loss of Medicaid to enroll in an ACA plan. Many people losing Medicaid will be eligible for a very affordable plan through the ACA. CMS estimates that millions of people will enroll in ACA plans throughout the unwinding process, adding to the already 14 million Americans currently enrolled right now.
If you receive a letter from your Medicaid agency, don’t put it aside. It’s important to follow the instructions as soon as possible to see if you are still eligible. If you’ve moved since you signed up for Medicaid, contact your state agency to update your address.
If you are no longer eligible for Medicaid, you may be eligible for a $0 or low-cost ACA plan. American Exchange’s benefits management experts can help you find a plan that meets your health needs.
Call 1.888.995.1674 or visit americanexchange.com/health-coverage.
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