What you need to know about Medicaid eligibility and redetermination
Montana health officials are set to begin a nearly yearlong process of reviewing the eligibility of every Medicaid recipient in the state. As a result, some may lose their coverage.
April 1 will mark the end of continuous Medicaid coverage put in place by federal officials three years ago to prevent people from losing healthcare during the COVID-19 pandemic. Redetermination will be a huge undertaking for the state health department with wide-reaching impacts on nearly one-in-three Montanans.
Here is the state health department’s page on the process.
Montana Public Radio reporters assembled this guide for what current Medicaid recipients should know about redetermination.
What is “Medicaid redetermination,” and how many people will it affect?
Nearly 320,000 Montanans are currently enrolled in Medicaid, according to state data. That’s 80,000 more people compared to March 2020, when the federal government told states they couldn’t unenroll people because of the coronavirus pandemic.
Starting April 1, Montana, and other states, will begin the process of determining whether people’s incomes, or other circumstances, have changed over the past three years in a way that would make them or their families ineligible for Medicaid services.
The state hasn’t said how many people could lose coverage, but one report from George Washington University that had input from the state health department estimates more than 70,000 people could lose coverage because they’re no longer eligible. That would set Montana’s Medicaid rolls back to their pre-pandemic numbers.
How will the redetermination process play out?
State health officials say they will work through the redetermination process within 10 months, meaning the last cases should be processed in January 2024. Different groups of people and Medicaid programs will be up for redetermination throughout that time period, says Olivia Riutta with the Montana Primary Care Association.
“The good news is there's some very clear things that folks can do to prepare,” Riutta says. “The first thing is to update your contact information with the Office of Public Assistance.”
You can update your contact info in a number of ways.
- Online at apply.mt.gov.
- By calling the public assistance helpline at 1-888-706-1535.
- Visiting your local office of public assistance.
- Find local, in-person assistance at covermt.org.
After I update my contact information, what should I be on the lookout for?
The state health department will be able to determine eligibility automatically for some people if it has their contact information, income and other details such as household size. If you are automatically renewed, the state will send a letter indicating that is the case.
But the department might need more information from some people. If that’s the case, the state will mail you a renewal packet. This won’t be sent via text or email, according to the department.
You’ll have about a month to mail the completed packet back or finish it online at apply.mt.gov. If you don’t receive or return your packet, you’ll lose coverage, even if you’re still technically eligible. It’s critical that current recipients of Medicaid services check their mail or PO box regularly to make sure they don’t miss their packet.
When will I be up for redetermination?
The state will process current Medicaid rolls over a 10-month period, but not everyone will be redetermined at the same time. Starting April 10, you’ll be able to log in to your online portal at apply.mt.gov to see which month you or your family members are set to be redetermined.
But, experts and the state both say that people on Medicaid services should be on the lookout for communication from the state at all times, and shouldn’t wait to open mail from the state, either.
I completed my redetermination packet, and the state said I’m ineligible. What can I do now?
People can become ineligible for a number of reasons, such as an increase in income beyond the eligibility threshold, a change in household size or needing to transition to Medicare at age 65 or older.
For those losing coverage due to ineligibility, the state says it will send a notice at least 10 days before coverage ends. That could mean a short window to find new insurance in order to avoid a gap in coverage.
Here are some possible insurance alternatives:
The insurance marketplace at HealthCare.gov.
- The state says it will send the marketplace your information automatically to make the transition smoother and will provide information on how to sign up.
- Ask your employer if they offer plans that fit your needs.
You can also reach out to Cover Montana to learn more about your options. Cover Montana operates a help line you can call too and you can also find in-person help on their website.
Olivia Riutta with Cover Montana says between those resources, there should be enough capacity to help people find new insurance
“The challenge is making sure we are able to reach people and work with folks in this very short time frame to make sure they don’t have a gap in coverage,” Riutta says.
I believe I lost Medicaid coverage due to an administrative or procedural error. What can I do?
If you lost coverage and believe you meet the qualifications for Medicaid, you can submit a new application. But, that process is likely to take time given the state’s workload.
Megan Dishong with the Montana Legal Services Association also says you can appeal if your application is denied. The association helps to answer appeal questions and sometimes represents people in the administrative appeals process, but says it will be hard to serve everyone.
“I do have concerns about the volume of claims,” Dishong says. “I just have concerns that they aren’t going to be able to handle the capacity, and we’re going to see real delays in adjudicating claims and processing new claims, and that could lead to gaps in coverage.”
Is the state prepared to handle the workload from Medicaid redetermination?
Experts like Olivia Riutta with the Montana Primary Care Association and Jackie Semmens with the Montana Budget and Policy Center worry that the state may face challenges during redetermination, as it has historically struggled to process new applications in a timely manner, compared to other states.
Semmens says she’s concerned for people on reservations and in other rural areas, even if people have all of their contact information up to date.
“If you’re in a rural area where you don’t have internet, you don’t have cell phone, your mail isn’t running consistently or you can’t get to your PO box every couple of days, it’s going to be very easy for people to fall through the cracks there,” Semmens says.
Semmens and others worry the state is trying to move too fast by working through redetermination within 10 months, rather than the 14 months allowed by the Centers for Medicare and Medicaid services.
What is the state saying about its ability to handle the workload?
The state Department of Health and Human Services declined an interview request about how it plans to handle Medicaid redetermination. In an emailed statement, DPHHS spokesperson Jon Ebelt says the agency has been improving application processing times for new applications and it’s hiring a consulting firm to help with the process.
Ebelt says the state has chosen Public Consulting Group, which will help kick off the process in April. The organization’s contract currently runs through July, so it won’t be on board for the entire process.
The state is able to use federal Medicaid funding, according to the contract, meaning the state will only pay a quarter of the total cost. The consulting group will be paid based on how many redetermination cases it completes. At this time, it’s unclear how much the total bill will be, but the state did cap it at $2.2 million.
As for why the state is trying to complete the process in 10 months rather than the allotted 14-month period, Ebelt wrote, “processing redeterminations expediently is in the best interest of Medicaid members and Montana citizens.” He added the state is committed to that timeline.
Is there anything else I should know?
One more thing — for people who stay on Medicaid after redetermination ends, or join Medicaid for the first time after April 1, the state is changing how often it will evaluate eligibility.
Going forward, every time your circumstances change — your income changes, your household size increases or decreases, etc. — you’ll have to update the state right away. Those changes will initiate a new redetermination process to see if you’re still eligible. This is a change from before the pandemic when the process happened once a year, even if your circumstances had changed.