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What does this mean for you?
It means that your state’s Medicaid agency will review your current info to decide if you still qualify for benefits. Your eligibility is based on rules set by your state. Your state’s agency may reach out to you if they need more details from you.
Answers to common questions
Public health emergency (PHE)
What is the federal “public health emergency” (PHE) and how does it affect Medicaid enrollment?
A public health emergency (sometimes called “PHE”) was announced in March 2020, when the COVID-19 pandemic began. As part of the PHE, state Medicaid agencies continued health care coverage for people enrolled in Medicaid, even if they were no longer eligible. However, that rule ended March 31, 2023, even though the PHE did not.
Do I still get to keep my Medicaid coverage as long as the PHE continues?
No. The continuous coverage rule ended March 31, 2023. So even though the PHE continues, you’ll need to show you’re still eligible for Medicaid. You’ll need to do this every year, as you did before the pandemic.
Medicaid eligibility and enrollment
What does it mean to be “eligible” for Medicaid?
To apply for and receive Medicaid or Children’s Health Insurance Program (CHIP) benefits, you must first prove you meet certain residence and income requirements. Each state has different eligibility rules for Medicaid.
How do I know if I’m eligible for Medicaid?
To learn more about who is eligible for Medicaid, check with your state’s Medicaid website. You can also visit the U.S. Department of Health and Human Services website.
What does it mean to “enroll” in or sign up for Medicaid?
Once you prove you are eligible for medical assistance, you can enroll in Medicaid. In states with managed care, you can then choose a health plan (such as Aetna Better Health) to enroll in. Each state has different offerings. This process is called “enrollment” and it’s good for one year.
In most cases, you’d need to prove you’re eligible again before you can re-enroll in Medicaid for another year.
What might make me ineligible for Medicaid?
It’s possible to qualify for Medicaid at one point, then become ineligible or lose that coverage later. Here are a few possible reasons why that might happen:
- Earning too much money (above the income limit)
- Failure to report a change in family status (getting married, for example)
- An end in pregnancy
- Receiving a gift or an inheritance
- Moving to a state with different income limits
What if I am no longer eligible for Medicaid?
If you no longer qualify for Medicaid, you may be able to get coverage you can afford from other options, such as the Affordable Care Act (ACA) marketplace.
Learn about other coverage options
- Arizona, California, Illinois, New Jersey, Virginia, Texas or Florida state residents (in select counties): Aetna CVS Health™ ACA plans offer coverage if you’ve had a qualifying life event. To learn more, just visit the Aetna CVS Health Marketplace website.
- All other state residents: Find local help to learn about your coverage options and get help with your application.
Will my child still be covered even if I am no longer eligible for Medicaid?
Children and teens can stay covered as long as they still qualify for Medicaid.
Redetermination (renewals)
What is Medicaid renewal or “redetermination?”
Medicaid renewal (also called Medicaid “redetermination” or “recertification”) is when you renew Medicaid benefits. Your state will use the info they have to decide if you still qualify for Medicaid or CHIP coverage*.
Be sure to finish your renewal by your state’s deadline. If you don’t, you may lose your benefits.
What do I need to do during the Medicaid renewal and redetermination process?
It’s very important that your state Medicaid agency or caseworker has the right contact info from you. If you’ve changed your address or phone number, you should let your Medicaid agency know right away.
They’ll send you info and instructions on how to maintain your health care benefits. Be sure to open any mail you receive from your Department of Social Services or Medicaid office.
Does the renewal and redetermination process vary by state and/or specific Medicaid programs?
Yes, the process is based on whichever state and Medicaid program members are enrolled in.
For instance, there are different processes for different Medicaid eligibility groups, such as:
- Children
- Adults under age 65
- Parents and caretaker relatives
- Pregnant women
- People receiving supplemental security income (SSI)
- Seniors aged 65 and older
- People with disabilities requiring long-term services and support
- People who need a nursing facility level of care or long-term services and support
What does the Medicaid renewal and redetermination process involve?
Medicaid members must report any change in income or assets (normally this is required even when it’s not renewal time). To ensure that members are still under the income and asset limits, the Medicaid agency reviews:
- Residency
- Bank accounts
- Taxes
- Income
- Pension statements
- Home equity
- Other financial documents
* In some states, CHIP recipients are not going through the redetermination process. Please review your state’s specific redetermination plan by visiting www.medicaid.gov.