Important information regarding Medicaid redeterminations in your state

October 2023

As of April 1, 2023, states can begin redeterminations to decide if individuals and their family members qualify for coverage through Medicaid or the Children’s Health Insurance Program (CHIP). Members need to take steps to find out if they can continue their coverage through Medicaid or the Children’s Health Insurance Program (CHIP). This is because states are resuming Medicaid and CHIP eligibility reviews, per the December 2022 federal omnibus bill that decoupled the public health emergency (PH) from CMS’ annual Medicaid enrollment process.

This means some patients with Medicaid or CHIP could be disenrolled from those programs, but they may be eligible to buy a health plan through the Health Insurance Marketplace or their employer.

What you can do to help your patients prepare

You can help by reminding your patients who have Medicaid to:

• Update their contact information with the state, ensuring their mailing address, phone number, email or other contact information is correct
• Check their mail and email for information from the state about coverage and reinstated renewal requirements
• Complete their renewal application promptly and return it to their state to help avoid a gap in coverage

What you need to know

• Each state is handling redeterminations differently. Please direct specific questions to your state Medicaid agency.
• For more information, please call the number on the member’s ID card
• If a patient or their family member no longer qualifies for Medicaid or CHIP, they may be able to buy a health plan through the Health Insurance Marketplace or their employer
• It is important to always verify member eligibility and benefits prior to rendering services. Services rendered to members who are not eligible of the date of service, will result in a claim denial.

Resources

For more details on redeterminations, go to Medicaid.gov.