The Biden administration extended the public health emergency declaration related to the COVID-19 pandemic through October 2022, temporarily alleviating immediate concerns about the loss of Medicaid for 15 million people when the declaration is lifted.
The threat of lost coverage, however, has just been kicked down the road. The COVID-19 pandemic-related mandate insured that if you were enrolled in Medicaid during the pandemic, you could not lose your coverage. When the emergency period is over, however, millions will need to meet eligibility requirements and re-enroll in Medicaid, some for the first time since the start of the pandemic. Officials warn that unwinding Medicaid’s continuous enrollment will be complex and may cause serious disruptions to individuals and families.
There are many ways to lose Medicaid — here’s how to handle being dropped
Medicaid is designed to be a health care safety net for those living near or below the poverty line, including individuals and families, the elderly, people with disabilities and pregnant women. The state-administered benefit has a set of specific criteria for disqualification, some of which are:
- Not meeting the income threshold
- Not notifying the Medicaid office of a change in family status (e.g. divorce, marriage or the birth of a child)
- Receiving a windfall of cash in the form of a gift
- Moving to another state with a different set of Medicaid requirements
- Missing the enrollment deadline or failing to submit eligibility documentation
Those who have been continually enrolled since the onset of the pandemic but who have experienced one or more of these changes can find themself at risk of losing coverage when the mandate is lifted.
While losing Medicaid can be scary and challenging, there are actions you can take if you are removed from the program.
Enroll in a short-term plan
Short-term insurance can act as a temporary stop-gap if you lose Medicaid coverage. Plans typically last for one year, depending on your state of residence’s policies. Short-term or temporary insurance may have a low premium (the average cost varies but could be as low as $124 a month) but you’ll likely see high deductibles and other restrictions.
For example, you may not qualify for a short-term plan if you have a preexisting condition, like diabetes, asthma or arthritis. Most short-term plans do not cover what the Affordable Care Act (ACA) describes as "essential benefits" like ambulatory services, lab costs, mental health care and coverage of prescriptions. Healthy individuals or families needing a safety net in an emergency can benefit from short-term plans, but coverage will vary depending on the provider.
Appeal the decision
If you are denied Medicaid coverage or it is terminated, you can reapply via appeal. You must submit your appeal no more than 90 days after you receive your denial letter. It is essential to review your Medicaid denial or termination letter to understand why you were dropped from the program. Submitting your appeal in person, in writing and date stamped may help you with the process. Remember that Medicaid is overseen by the state you live in, so you must follow their rules, not the rules of another state. If you don’t win your repeal, you can always wait to reapply the following enrollment period and supplement with another form of income-based health insurance.
Review your options on the health exchanges
If you lose your Medicaid coverage, you can enroll in an ACA plan even if you've missed the official enrollment window. Former Medicaid recipients receive access to a Special Enrollment Period (SEP), which allows you to find medical coverage on the exchange during a 60-day window. There are online tools that can help you find an affordable plan that fits your needs and budget. While not as inexpensive as Medicaid, you may qualify for a discount based on your income by receiving a government subsidy to help you pay a plan's monthly premium. The subsidies can cover as little as 1% to 100% of your monthly premium, but not everyone will qualify.
Only enroll your child
If you can't afford coverage for yourself but want to purchase a policy for your child or children, child-only policies might be an option. A child is defined as anyone under the age of 17 or 19, depending on the state. You can purchase insurance for your child from the public and private sectors. You may have to meet income eligibility requirements to qualify for no-to-low-cost, child-only insurance.
One well-known option is the Children's Health Insurance Program (CHIP). This program covers recipients under the age of 19 in most states. It is tailored to provide affordable coverage to families who don't qualify for Medicaid but cannot afford to purchase private insurance. In addition, you can apply for a child-only policy under the ACA, and some private insurance companies also sell child-only policies.