What Is Medicaid Redetermination?

When Does Medicaid Redetermination Happen?

Prior to the COVID-19 Public Health Emergency (PHE), enrollees were typically subject to an annual eligibility renewal process 12 months after their initial enrollment date. However, during the PHE, redeterminations were paused for most beneficiaries, including those enrolled in Medicaid or CHIP coverage before the PHE began and those who became eligible for coverage during the PHE.

As states are restarting Medicaid Redeterminations on varying dates, your redetermination may occur on a different date than it has in the past. Your state Medicaid agency will notify you before your annual Medicaid Redetermination review.

 

What Are The Rules And Guidelines For Medicaid Eligibility?
 

Medicaid and CHIP eligibility can vary state to state. Generally, Medicaid coverage is available to people with low incomes, including families, children, pregnant women, older people, and those with disabilities. 

Typically, Medicaid eligibility is based on income for those aged 19–64. Some individuals are exempt from income counting rules, including those whose eligibility is based on disability or age (65 and older).
 

Does Medicaid Redetermination Affect You?
 

Since the COVID-19 PHE first began in March 2020, Medicaid and CHIP membership grew to nearly 95 million people.¹ As the redetermination process resumes in 2023, many may no longer qualify due to changes in age, income, or other factors.  

It's important to check your state’s Medicaid and CHIP qualifications to know if you are eligible to remain covered. 
 

What Is The Highest Income To Qualify For Medicaid Or CHIP?
 

Income guidelines for Medicaid and CHIP vary by state. In most cases, Medicaid and CHIP income qualifications depend on the size of the household. Here are some example income limits:

• $14,580 for Medicaid for an individual

• $50,560 for Medicaid for families of up to eight members 

• $60,000 for CHIP for families of four with children up to age 19

Visit your Medicaid.gov for specific income qualifications based on where you live.

If you earn too much to qualify for Medicaid or CHIP, you have coverage options. These can include Medicare, an insurance plan sponsored by your employer, or an Anthem individual or family health insurance plan offered through the Health Insurance Marketplace (Marketplace). In fact, some Marketplace plans are available as low as $0 a month.*

 

Who Decides If You Can Continue Receiving Medicaid Or CHIP Coverage?
 

Your state Medicaid agency will conduct its eligibility review to determine if you qualify for coverage. Your state Medicaid agency may also review your income, as well as existing assets, and take into consideration other factors such as disability, pregnancy, age, and household size when determining eligibility.

 

What You Can Do To Renew Medicaid Or CHIP Coverage
 

Here are three things you can do to begin preparing for the redetermination process:

1.  Update your contact information – your state Medicaid agency may contact you about renewing your coverage, including any steps you need to take. Be sure they have your current mailing address, phone number, and email.
    

2. Watch the mail – your state Medicaid agency will send you a letter about your coverage and the redetermination process. The letter will let you know if you need to take any action and/or provide information to help your state determine if you still qualify for coverage.
    

3. Complete your renewal form – if you receive a form, fill it out completely and return it to your state Medicaid agency by the due date provided. This will help prevent a lapse in your coverage. 
   
   

Learn more about renewing your Medicaid or CHIP coverage 
 

What Can You Do If You No Longer Qualify For Medicaid Or CHIP?
 

If you no longer qualify for Medicaid or CHIP, you’re eligible for a special enrollment period (SEP) to enroll in new healthcare coverage. The length of the SEP may vary based on the type of coverage you’re considering and by state. 

During this time, you may consider enrolling in Medicare, a health plan sponsored by your employer or an Individual and Family Marketplace health plan. Marketplace plans cover essential health benefits including prescription drugs, doctor visits, urgent care, and hospital visits.
 

If eligible for a Marketplace plan, you may also qualify for an Advanced Premium Tax Credit (APTC), also known as a subsidy, that will save you money on any Marketplace plan you select. In fact, 9 out of 10 enrollees qualify for a subsidy.²  Individuals who purchase a Marketplace plan may also qualify for cost-sharing reductions (CSRs), which are extra savings that reduce out-of-pocket costs by lowering your deductible, coinsurance or copays, and out-of-pocket maximum.
 

Learn more about cost-sharing reductions 

 

We Can Help You Navigate Your Health Insurance Options
 

Count on our experience and support when you enroll in a health plan. If you’re no longer eligible for Medicaid or CHIP,  we can help you understand your options to stay covered.