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What Employers Should Know About Medicaid Renewals

A Consumer-Centered Health System Story
April 4, 2023

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. 

The Impact of Resuming Medicaid Redeterminations

The suspension of Medicaid redeterminations during the COVID-19 PHE has helped millions of families retain coverage over the last couple years, leading to the largest ever Medicaid enrollment of 84 million people as of October 2022.

States are responsible for managing the Medicaid renewal process for their Medicaid programs, and each state has its own approach and timelines. People who remain eligible for Medicaid will need to complete renewal paperwork so they do not lose coverage, a process that was paused during the pandemic. For some individuals, this may be the first time they experience a redetermination of eligibility.

“States need to process Medicaid eligibility redeterminations for nearly every person in their program — a significant and unprecedented undertaking,” said Aimée Dailey, president of Medicaid at Elevance Health. “The need to make sure individuals are able to retain Medicaid coverage or enroll in other healthcare coverage is critical.” Efforts will vary state to state, she said, depending on what individual state programs and efforts look like.

Among the estimated 15 million people who could lose Medicaid coverage, the Department of Health and Human Services estimates that:

  • 20% to 25% will become covered through an employer
  • 15% to 20% will enroll in individual ACA coverage
  • 15% will have had another source of insurance coverage in addition to Medicaid, also known as double coverage
  • 5% to 10% will go without insurance

“Collaboration and planning are really what’s needed to make sure people retain their healthcare coverage when Medicaid redeterminations resume,” Dailey said. 

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For More Information

Elevance Health is committed to improving health affordability, quality, equity, and access. As part of this commitment, we are simplifying the Medicaid renewals process so individuals can understand and enroll in the coverage they need to keep themselves and their families healthy. We introduced to help people in select states* receive personalized guidance on current benefits eligibility — including health insurance coverage and other benefits like food, childcare, and housing. There are also resources to help them learn more and enroll.

What Employers Can Do to Support Medicaid Beneficiaries

The good news is that there are steps that can be taken to help current Medicaid members renew their coverage or find other options.

  • Let employees know that a loss of coverage, including Medicaid coverage, is a qualifying event that allows employees to enroll in employer-sponsored coverage.
  • Make all employees aware of the need to update their current mailing address and phone number if they currently have Medicaid coverage. This will help to ensure they will receive communication from their local Medicaid agency.
  • Provide employees with information about the health plan (and financial subsidy, if applicable) you offer as part of their benefits package. You can also direct employees to to help them find health plan coverage options going forward. 

*California, Georgia, Indiana, Kentucky, Missouri, Nevada, New York, Virginia, Wisconsin, Florida, Iowa, Louisiana, Maryland, Minnesota, Nebraska, New Jersey, North Carolina, South Carolina, Tennessee, Texas, Washington, and West Virginia. 

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