Every year, states review their Medicaid enrollment to determine who is eligible to remain on Medicaid and who is no longer eligible for the public health insurance program based on their residency, their income, and other factors. This is called Medicaid eligibility redetermination, or Medicaid renewal, and it was a regular practice until January 2020. That’s when the United States government declared a public health emergency (PHE) in response to the COVID-19 pandemic and Medicaid redeterminations were paused.
During the public health emergency (PHE), nearly all Medicaid and Children's Health Insurance Program (CHIP) members kept their coverage, regardless of changes in eligibility or status. However, legislation signed on December 29, 2022, allowed states to begin removing ineligible members from their Medicaid programs starting April 1, 2023.
What Happens if Someone Is No Longer Eligible for Medicaid?
During the Medicaid renewal process, an estimated 15 million people could lose their Medicaid coverage — either because they no longer qualify, because of a missed paperwork deadline, or because they didn’t receive renewal communications due to an address change.
If someone can’t get health insurance through their employer and they are under age 65, they can buy an individual or family health plan through the health insurance marketplace. Marketplace health plans cover essential health benefits, including doctors’ services, hospital care, prescription drugs, and mental health services. Individual marketplace health insurance plans are available to anyone who does not have health insurance, including people no longer eligible for Medicaid coverage. People may also be eligible for financial help (a subsidy) that could lower their monthly payment (premium). Typically, people have 60 days from the date they lose Medicaid coverage to apply for a health insurance marketplace plan, or to sign up for coverage through their employer.