Medicaid Beneficiaries and Their Providers Must Verify Coverage

As of April 1, 2023, state Medicaid programs can discharge Medicaid beneficiaries based on program eligibility criteria including income or eligibility for employer-sponsored insurance coverage. Though states have more than a year to complete this process, Medicaid beneficiaries in five states (Arizona, Arkansas, Idaho, New Hampshire, South Dakota) will be among the first to go through this nationwide administrative procedure that will determine health care coverage for around 15 million people. The redetermination process can be uncertain and difficult to navigate; therefore, audiologists and speech-language pathologists who see Medicaid enrolled beneficiaries should encourage those patients to verify their insurance coverage as soon as possible.

Redetermination Process

The Families First Coronavirus Response Act (FFCRA) required state Medicaid programs to keep all beneficiaries continuously enrolled in the program; thereby, halting the regularly scheduled eligibility redeterminations that states normally conducted. Keeping beneficiaries continuously enrolled helped ensure as many people as possible had health insurance during the pandemic. However, the continuous enrollment requirement was lifted on April 1, 2023, which means that state Medicaid programs will disenroll beneficiaries who no longer meet eligibility requirements.

State Medicaid programs will use the enrollment information they have for each beneficiary to decide if beneficiaries still qualify for Medicaid or CHIP coverage. Beneficiaries must ensure that the state Medicaid agency has updated contact information for them. If a state needs more information from a beneficiary to make a coverage decision, they’ll send a renewal letter in the mail. Certain families may have some members who continue to qualify for Medicaid, and others who must switch to other coverage (e.g., an adult and their child). Those former Medicaid beneficiaries will need to identify alternative health insurance coverage.

The FFCRA also expanded Medicaid eligibility for uninsured people during the federal public health emergency (PHE), but that coverage will end with the expiration of the PHE on May 11, 2023. Those who are enrolled under this eligibility must seek alternative health care coverage (marketplace or private health plans) when the PHE ends.

Encourage Medicaid Beneficiaries to Verify Coverage

States are required to give notice by mail, with the additional option of texting, to all individuals who are no longer eligible for Medicaid before discharging them. It’s possible that those individuals who are unenrolled could qualify for Medicaid again if a change in their employment or income levels makes them eligible. Patients who have Medicaid for their health insurance may need referral to a health care navigator for help finding health insurance during a special health care marketplace enrollment period created for patients in their situation. Patients can also contact their state Medicaid agency through contact information available from Medicaid.gov.

Questions?

Contact ASHA’s health care and education policy team at reimbursement@asha.org.