Highmark: Medicaid Redeterminations - What You Need to Know

Medicaid Redeterminations: What You Need to Know

Millions of Americans are expected to lose their Medicaid-related health coverage due to the continuous enrollment requirement for Medicaid that ended on April 1, 2023.

This will be a disruptive, stressful time for our members and your clients affected by this change and agents need to be there for them as a resource, helping them find the best and most appropriate health plan based on their individual situation.

Background

• In response to the COVID pandemic, the federal government declared a Public Health Emergency (PHE) on January 31, 2020. Income eligibility requirements for Medicaid were waived, to help millions of Americans who lost their employer-sponsored health insurance.
• On April 1, 2023, Medicaid began to redetermine eligibility and many current Medicaid recipients will be disenrolled. Highmark estimates that more than 3.8 million members and their families across the four-state service area will be redetermined and may lose coverage.
• States will have 14 months to redetermine their entire Medicaid population for eligibility in the program going forward. Medicaid redeterminations, including terminations from coverage, will happen gradually over time and not all at once.

What are Medicaid Redeterminations? When will Medicaid Redeterminations begin?

• Pre-pandemic, Medicaid & CHIP beneficiaries were required to go through annual eligibility requirements to make sure they qualified for benefits.
• As of January 2020, a continuous coverage requirement was created for Medicaid & CHIP that ceased these renewal requirements. All beneficiaries remained enrolled even if they no longer would qualify.
• As of April 1^st, the continuous enrollment requirement has ended, and states have begun to effectuate coverage renewals & terminations. Many people will lose coverage.
• Pennsylvania & West Virginia started on April 1^st, Delaware will start on May 1^st.

What does the beginning of Medicaid Redeterminations mean for current Medicaid recipients?

• They will need to complete an eligibility renewal ASAP in order to keep their Medicaid coverage.
• They should be on the lookout for their renewal forms and make sure their contact information is up to date with their state Medicaid department:
• PA State Customer Service Center:  Phone: 877-395-8930; Website: dhs.pa.gov/COMPASS
• WV Department of Health and Human Resources: Phone: 877-716-1212; Website: wvpath.wv.gov
• DE Medicaid Customer Relations: Phone: 302-571-4900; Website: assist.dhss.delaware.gov
• New York State Department of Health: Phone: 800-541-2831; Website: health.ny.gov/health_care/medicaid/changes/
• If they have questions about their case, they should reach out to their state’s Medicaid department.

What happens if a Medicaid recipient is no longer eligible?

• Your clients have options to make sure they remain covered: affordable, high quality Highmark ACA plans!
• There are new ACA Special Enrollment Periods (SEP) to help people stay covered.
• In Pennsylvania, the usual timeframe to enroll has been extended from 60 days to 120 days. This longer window of enrollment will last through Spring of 2024, when redeterminations are complete in Pennsylvania.  
• In West Virginia & Delaware, those with a last date of Medicaid coverage between March 31, 2023 and July 31, 2024 can qualify for a Special Enrollment Period to enroll in ACA coverage. They will have 60 days to select a plan once they qualify for the SEP.
• In all states, consumers can report a loss of coverage up to 60 days before their last date of coverage.  
• For those with children under the age of 19, Highmark CHIP has quality/affordable options. Enrollment is year round.