Here’s what to do if you get a notice that your Medicaid coverage is ending. The first step is to find out why.
Medicaid provides healthcare coverage to more than 85 million Americans with low incomes. Getting notice that your coverage is ending can send you looking for answers — and alternative healthcare coverage.
In response to COVID-19, the federal government provided additional Medicaid funding to prevent people on the program from losing healthcare coverage. But now that this additional funding has ended, millions of people may lose Medicaid benefits or have to re-enroll between now and mid-2024.
Here’s what to do if you receive a notice about your coverage ending.
Reasons for termination of coverage
- income increases, including receiving a gift or inheritance
- a move out of state
- pregnancy or parenting status change
- family status change, like getting married
- a change in disability status
- turning 26 and aging out of foster care eligibility
Medicaid is funded by both federal and state governments. But each state sets its own eligibility rules, so you’ll need to contact your state agency for answers to your eligibility questions.
Programs are required to notify Medicaid participants of changes to their coverage. These notices might go undelivered if you’ve moved to a new address or changed your email address. You might find answers to your questions by logging into your online account. Otherwise, contact your local Medicaid office to ask.
When you call, have eligibility information handy. You might also need to verify your address, number of people in the household, and household income.
If you’re unsure whether you still qualify for Medicaid benefits, this online tool can give you a quick assessment.
It’s common for people to go in and out of eligibility as their income changes. If you get a temporary boost in income, such as through seasonal employment or an inheritance, you might become ineligible for Medicaid assistance. You’ll have to reapply each time you become eligible.
If you received a notice to verify your eligibility, check whether the letter is requesting information. In some cases, you may just need to fill out a form or verify your income to continue receiving Medicaid benefits.
If you’re no longer eligible for Medicaid health coverage, you may have other options. But don’t delay. Some options come with limited enrollment periods:
- ACA plans for people under 65: You can check healthcare.gov for Affordable Care Act (ACA) plans available in your area. Tax credits to help cover the cost are available for those who qualify. To enroll in an ACA plan, you must apply within 60 days of the date Medicaid coverage was lost.
- Medicare for people over 65: If you’re 65 or older, you may qualify for Medicare. Visit medicare.gov to learn more and explore plan options. You have 6 months from the date Medicaid coverage ends to enroll in a Medicare plan.
- Plans for residents of New York or Minnesota: Residents of these states can apply for a basic health program that offers stability to people whose income sometimes disqualifies them from Medicaid. Other states are considering similar programs.
- Short-term health plans: These plans bridge the gap between losing Medicaid coverage and regaining it or access to Medicare or an employer’s health plan. Rules for short-term health plans vary by state. These plans do not have the same protection as ACA plans, so pre-existing conditions might not be covered. Purchase these plans through private insurance companies.
- Community health centers: People without health insurance can get reduced-price medical care at community health centers. Find one near you at nachc.org or find free and charitable clinics at nafcclinics.org.
- Emergency departments: Emergency departments are required to stabilize people regardless of their ability to pay. Many hospitals also provide free or reduced-price care to people who are unable to pay. Ask your hospital about charity care if you need help paying for services.
Navigating insurance and care in the healthcare system can be confusing, but help is available. Healthcare advocates, also known as ombudsmen, case managers, or health navigators, are often on staff at medical centers, senior living facilities, and health insurance companies.
Healthcare advocates can:
- review medical charges
- negotiate bill payments
- find programs to help with payment
- explain insurance policy terms
- help you get the most out of your health plan’s benefits
- advise you on your rights
- help schedule healthcare visits and arrange transportation
- help you find a health insurance product that fits your needs
Keep in mind that advocates work for the organization that employs them. Their allegiance might be to the healthcare system or insurance company they work for.
You can also hire your own patient advocate. You can find a patient advocate using one of the following directories:
The government offers a little extra help for individuals or families with high healthcare expenses. If the cost of qualifying medical and mental health care adds up to more than 7.5% of your adjusted gross income, you can deduct those expenses from federal taxes.
This includes the cost of care and supplies for dependents. Make sure to keep receipts for the expenses and talk with a tax preparer for more information.
If you disagree with a Medicaid program’s decision, you have the right to appeal. If you think you were deemed ineligible by mistake, file an appeal.
To appeal a decision, follow your state’s process. The appeal has to be filed in a timely manner. For some states, the window is as short as 20 days. Other states may allow up to 90 days.
Some states require that requests for appeals hearings be made in writing and either mailed, faxed, or hand-delivered. You might be able to request that your Medicaid coverage remains in place during the appeal process, but make sure to make the request before the date coverage is set to expire.
Medicaid provides healthcare coverage to millions of Americans. But if you lose eligibility, you have options. A few basic steps can help you get the healthcare you need and deserve.