How Seniors Can Avoid Losing Coverage During Medicaid’s Unwinding Period

During the COVID-19 pandemic, health care was in an obvious crisis. In addition to healthcare workers navigating how to treat patients in overwhelmed hospitals and perform needed operations within the strictures of quarantine, many people found themselves without health insurance and access to care. 

In response to the public health emergency, Congress passed the Families First Coronavirus Response Act. The act required states to continually enroll beneficiaries until the end of the COVID-19 emergency—if they wanted to keep their funding. The primary goal was to give Medicare-eligible Americans in crisis access to medical care. They also wanted to remove the fear of being forced to change insurance plans during a public health emergency. 

With the pandemic officially over as of April 2023, the continuous enrollment provision is also ending. Since there has been such major growth in Medicaid enrollment, the impending elimination of the provision requires an eligibility review of all current beneficiaries on Medicaid and either a renewal or removal of their benefits. The review is being referred to as the “unwinding of the continuous enrollment provision.”

As a senior, this unwinding of the Medicaid continuous enrollment provision will only impact you if you’re on Medicaid in addition to Medicare. We know Medicare and Medicaid can be confusing even without a major change like the unwinding! So, we’re taking a look at what you need to know about this situation and some suggestions on moving forward if you think you’ll be affected.

How many people were affected by the continuous enrollment provision? 

From the start of the COVID-19 pandemic to the beginning of the unwinding period in March 2023, 23.3 million people were enrolled in Medicaid. This means there are about 95 million Americans on Medicaid right now. Of course, this growth can’t only be attributed to the provision. Economic issues and recent Medicaid expansions also played a role. 

So how did the continuous enrollment provision impact Medicaid? Essentially, states couldn’t disenroll beneficiaries, even if they were no longer eligible, if the state wanted to keep their federal funding. This helped millions retain their coverage. 

Now that the provision is lifted, states can disenroll beneficiaries from Medicaid without jeopardizing their federal funding. Of course, there are still regulations in place to protect Medicaid beneficiaries who are appropriately enrolled. For example, states can’t change how they determine your eligibility, increase your premiums or disenroll you without giving you notice. 

Who will lose Medicaid coverage during the unwinding period? 

The exact impact of the unwinding period isn’t clear at the moment. But given Medicaid’s recent boom in growth, the number of people who will lose Medicaid coverage is commensurable. Some estimate that 5.3-14.2 million Americans will lose Medicaid coverage over what will be a one year unwinding period.

Disenrollment from Medicaid depends on a variety of factors, including changes in eligibility. Right now, experts suggest that the groups with the highest number of new Medicaid enrollments while the provision was in effect are at the greatest risk of losing coverage. 

The highest-growing groups during the period of February 2020-March 2023 were children under 19 and adults eligible under the Affordable Care Act. Seniors accounted for 5% (that’s 1.3 million individuals!) of new enrollees.

New enrollees aren’t the only ones who risk losing coverage. The unwinding also impacts beneficiaries who historically experience difficulty re-enrolling in Medicaid. If you moved and changed your contact information, have limited English proficiency or if you’re an individual with a disability, you could experience challenges completing your enrollment paperwork and find yourself without coverage—even if you’re actually eligible.

Will the unwinding process be different in different states?

The short answer: yes. The Medicaid program is administered by states based on their particular needs, although they’re still required to follow certain federal guidelines. The continuous enrollment provision is actually a function of this structure since states were federally incentivized to keep beneficiaries enrolled through the COVID-19 pandemic. 

Because Medicaid is left up to the states to administer, they’ll determine how the unwinding process will go. Each state is required to come up with a plan for how Medicaid renewals will be prioritized and processed. States are also expected to share strategies for keeping eligible enrollees from losing their coverage. 

The unwinding period kicked off with eight states in February 2023, but different states are on different timelines. Fifteen started their unwinding process in March 2023 and 28 more states, including California, followed on in April 2023.  

States in the unwinding period are currently contacting beneficiaries who are in danger of being disenrolled. All states have confirmed they’ve made efforts to update enrollee contact information over the past year. Forty-one states have also committed to following up with enrollees whose notification is unable to be delivered. 

What outreach is happening during this period? 

If you’re a Medicaid beneficiary, just knowing your coverage may be changing is an important first step. Because each state is handling this process differently, take a moment to verify how your state is managing the unwinding and what kind of communication to expect. 

In addition to a letter from your insurance provider, you may receive information through your state’s outreach initiative. Health plans and community organizations are also helping spread the word.

What should I do if I’m concerned? 

If you’re concerned you may lose your coverage, there are a few additional steps you can take. First, make sure your contact information is up to date within the Medicaid system. This way, you’ll be easy to reach if there are important updates to your plan.

Next, research the specifics of how the unwinding period will go in your state. If you believe your eligibility is the same and you’re concerned about re-enrolling at the appropriate time, reach out to your Medicare insurance agent to confirm you have the right dates and paperwork to maintain your coverage. 

If you’re concerned your eligibility has changed, there are still options available. Again, contact your insurance agent to check your eligibility and find out what plans are available to you. Since plans vary from state to state, your agent is the best resource to point you in the right direction.

If you’re enrolled in a Medi-Medi plan (using both Medicare and Medicaid), you may be able to switch to another Medicare plan even if your eligibility for Medicaid has shifted. The continuous enrollment provision was specifically for Medicaid, so your Medicare eligibility should remain the same.

By updating your contact information and reaching out to your insurance agent, you’ll be equipped with all the information you need to avoid a gap in coverage. 

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image credit: shutterstock/giedre vaitekune