Why are Seniors Suddenly Losing their Medicaid Eligibility?

Why are Seniors Suddenly Losing their Medicaid Eligibility?

Have you heard rumors about the elderly losing Medicaid eligibility? Unfortunately, those rumors might be true. Now that the pandemic has been declared “over,” many of the protections that were in place for Americans over the last several years are being rolled back. As a result, millions of seniors are discovering that their Medicaid eligibility is at risk.

Medicaid During the Pandemic

According to Medicaid.gov, about 83.7 million people were covered by the program in March 2023. Of those individuals, about 7.2 million are seniors who are also enrolled in Medicare. The program is administered by the states but is subject to federal requirements and oversight. As such, Medicaid is funded by the states and the federal government.1

When the pandemic hit, Congress created the Families First Coronavirus Response Act. This act did many things for those in the United States, including requiring the states to keep individuals on Medicaid through the end of the COVID-19 health emergency. This would ensure that no one lost their coverage during a time when they needed it most. In exchange, each state would get more federal funding for the program.

The End of the Pandemic-Era Medicaid Rules

Because those protections are now ending, some Medicaid coverage is ending, too.

Hearing rumors that you might lose your eligibility can be frustrating, especially if you are disciplined about making sure that your insurance and other healthcare safety nets stay in place. But even if you are the type of person who works very proactively for your health, such as making appointments with specialists and using an emergency alert for the elderly, a stroke of the pen somewhere in your state could mean that you will lose coverage for reasons beyond your control, and then you have to work to get it back.

During the pandemic, Medicaid coverage was extended to those who wouldn’t have normally been eligible under the income guidelines. Since April 1, 2023, states have been allowed to drop coverage for the first time since the pandemic began. According to the Kaiser Family Foundation, at least 1.5 million people spread across 22 states have lost their coverage as of June 30, 2023, and those numbers are going to keep rising.2

This is called the “unwinding” of Medicaid. And it can hit the elderly with a particularly hard ripple effect.

For instance, let’s say that your Medicaid coverage fills in the gaps for what you can afford in premiums and copays for Medicare Advantage. You might also get supplemental benefits from Medicaid that allow you to buy food or other necessities.

If you lose that Medicaid coverage, not only do you potentially lose that money to buy food, you also lose the premium coverage and copay assistance – which then leaves you in the difficult position of deciding if you can afford to go to the doctor, get the prescriptions you need, and put enough food on the table to give you adequate nutrition.

But the problem might not be that you make too much money to qualify under the new guidelines. Instead, about 76% of those who are losing coverage are being disenrolled in their Medicaid plan for “procedural reasons.” That means they didn’t complete a renewal application or didn’t produce the required documents in a timely manner – but often, that application and other information might have been sent to an old address or was difficult to understand and complete.

How many people are being pulled from Medicaid for these procedural reasons depends upon the state, with Kansas leading the pack at 89% and Iowa holding up the lower end with 28%. But even the lowest numbers in Iowa reflect more than one of every four individuals on Medicaid – that’s an enormous number of people losing their coverage who may still be eligible for benefits.

The Department of Health and Human Services estimates that as many as 15 million people will be dropped from Medicaid this year, and that 6.8 million of those individuals might still be eligible.

Obviously, this is a very serious problem.

How States Are Addressing the Issue

If you are on Medicaid, it’s important to learn how your state handles the issues of enrollment. States are required to submit something called a renewal distribution plan. They also have to make those plans public.

The Georgetown University Health Policy Institute can give you much more information about your particular state and their plan for making sure that everyone who is still eligible will stay on Medicaid.3

Most states have said they intend to take between 12 and 14 months to complete the renewals that determine who is eligible and who is not. Some states intend to complete this step in less than a year. All states took steps to update contact information for their enrollees over the past year, and most of those states intended to follow up with those who didn’t respond.

Some states will look at the information on file and make an automatic determination based on that; others will require a full application and documentation process.

What to Do If You Lose Medicaid

You might be nervous about what could happen if you lose your Medicaid. If your income has gone up significantly or anything else in your life has recently changed, you are probably aware that it could affect your eligibility.

But you could also get contacted by the state concerning your Medicaid coverage even if nothing has changed; your state could simply be reaffirming that you qualify.

Here’s what to do in either situation:

·        Respond to every request. If there are forms to be filled out, your state will send them to you via U.S. mail. However, the federal government also requires the state to contact you in another way – email, phone, or text message – to remind you to fill out the form. Respond to this request very promptly.

·        Offer up extensive documentation. Have all the documentation you might need to prove your eligibility. Though this might vary by state, it will usually include proof of income, information about other people living in the household, and details of your assets. Keep all of this documentation ready to go so you can easily fulfill any requests from the state.

·        Work with private organizations. If you find that the forms the state sends you are confusing, it’s time to get some help with them. There are many community groups dedicated to help seniors in your position. Get in touch with your Area Agency on Aging, senior center, or even a social worker to figure out where that help is in your local area.

·        Ask for an extension or grace period. If you get paperwork from the state that arrives within days of the due date (or even later), get in touch with your state immediately and ask them what to do. In some cases, the forms are just a formality. In others, they must have them completed in order to continue your coverage. If you are pushing the deadline (or already past it), ask if there is a grace period or a possible extension. In general, you will have 30 days to fill out and return the forms after you receive them, but the due date will always be listed on the letter.

·        Follow up on every step. When you do send in forms the state requests of you, follow up a few weeks later to make sure they were received and ask if they need anything else. This will help give you peace of mind that you have done your part to keep your eligibility intact.

·        Look into a backup plan. For some, the loss of eligibility isn’t a procedural matter – you might really make too much money to qualify. In that case, it’s time to have a backup plan to ensure that you can get the medical coverage you need. Look into different Marketplace plans to see if you qualify for anything within your budget, even if you already have Medicare – you might be able to find a plan that fills in the coverage gaps.

·        Remember the special enrollment. There will be a special enrollment period open until July 31, 2024, for those who lose their Medicaid coverage. You have up to 60 days after the termination of coverage to enroll in a new plan. If you need help with this, reach out to your local social services office.

·        Talk to a social worker. A social worker can help you navigate the intricacies of Medicaid eligibility. Contact your doctor, your local hospital, or any other community health organization, such as the health department. They can put you into contact with a social worker who can help you.

·        Do what you can to stay safe and healthy. Though you want to always be proactive about your health, staying safe is especially important when any sort of health coverage is on the line. To that end, do the things that matter to stay on top of your health: take your medications on time, keep your regular doctor’s appointments, see specialists if you need to, consider a medical alarm for a strong layer of protection and peace of mind, and keep up with the changes in your insurance, Medicare, or Medicaid situation.

The last thing you want is to suffer a fall or other injury when you are experiencing a lapse or gap in coverage. A button alert, especially one with GPS and fall detection, can help you stay as safe as possible. If you do suffer a fall or other accident, you can press the button to get help right away instead of lying on the floor waiting for someone to arrive. Opting for an affordable medical alert button is a strong step toward staying healthy!