17 Oct How to Keep Health Insurance During Medicaid “Unwinding”
Do you have Medicaid? Have you heard that Medicaid is “unwinding?” Wondering what that means? Have you, or someone in your family recently gone to the doctor or the pharmacy, and found out that your Medicaid coverage was cancelled?
This blog will explain what is Medicaid unwinding, what you can do to stay covered, other options for health insurance if you no longer qualify for Medicaid, and how you can help spread the word.
What is Medicaid Unwinding?
During the COVID-19 public health emergency (PHE), the federal government gave states more Medicaid funding, if they would keep people enrolled in Medicaid. This was called Medicaid “continuous enrollment.” The goal was to keep people insured during the pandemic so that they could get access to health care.
This special rule allowed people to keep Medicaid coverage even if they had a change in their income or family size that would have normally made them ineligible for Medicaid.
The Medicaid Continuous Enrollment ended March 31, 2023. As a result, states now need to “unwind” the Medicaid continuous coverage requirement. This means that states need to check to see who is still eligible for Medicaid. This process has started in most states.
As of October 11, 2023, more than 8.6 million people have been disenrolled from Medicaid.
It was expected that some people would no longer qualify for Medicaid, and their coverage would end. But 72% of people whose Medicaid coverage has been cancelled so far, had their coverage cancelled for procedural reasons. The most common procedural reason is that they haven’t returned their paperwork to show that they are still eligible for Medicaid.
This is concerning because people may not know that they need to submit this paperwork. People might confuse it for junk mail, or may have moved and the mail was not forwarded to them. Seniors and people with disabilities may also have challenges with getting the paperwork completed by the deadlines.
Unfortunately, people may not even realize that their Medicaid coverage has even been cancelled until they go to the doctor or try to pick up a prescription at the pharmacy.
What You Can Do to Stay Covered
There are some key steps that you can take to stay covered by Medicaid:
- Contact the state Medicaid agency today and update your mailing address and phone number. Find their contact information here.
- Watch for letters from the state Medicaid agency.
- Respond to renewal letters by the due date. If you don’t, you may lose your coverage even if you are still eligible.
- You can get free help navigating this process from assisters in your community. Find them at
- If you’re not eligible for Medicaid anymore, go to gov to see if you qualify for free or low-cost health insurance.
- Parents should respond even if you are not eligible or are enrolled in other coverage. Your children could still be eligible for coverage.
What to Do If Your Medicaid Coverage is Cancelled
If you lose Medicaid coverage and think you may still be eligible, you can appeal the denial of Medicaid coverage. For people who lose Medicaid for procedural reasons, they have 90 days to contact Medicaid and submit their renewal paperwork.
If they’re still eligible for Medicaid, the state is required to restore their coverage back to the date their coverage was terminated. People who miss the 90-day window must submit a new application for Medicaid.
Options If You No Longer Qualify For Medicaid
If you no longer qualify for Medicaid, you still have some options for health insurance, including:
- Marketplace Plan
People can buy a Marketplace plan from the State Health Insurance Marketplace (HealthCare.gov). There is a Marketplace Special Enrollment Period (SEP) for people who lose or are denied Medicaid or Children’s Health Insurance Program (CHIP) coverage because they are no longer eligible.
- You should submit a new application and enroll in a Marketplace plan as early as 60 days before your Medicaid or CHIP coverage ends to avoid a gap in coverage. Create an account(or log into an existing one) to start an application. The coverage begins the first day of the month after you choose a plan.
- From March 31, 2023, to July 31, 2024, you can also apply for a Marketplace plan any time after your Medicaid or CHIP coverage ends. The SEP can be used if you lost coverage in the past 60 days or expect to lose coverage within the next 60 days.
- You’ll have 60 days after submitting your application to enroll in a plan that will start at the beginning of the next month after you complete your enrollment.
- Depending on the size of your household and your household income, you may be eligible for financial assistance to help pay for your Marketplace plan. According to the CMS, four out of five customers should be able to find plans for $10 or less per month with financial help.
- To find a Marketplace plans, visit HealthCare.gov. Need help with the Marketplace? There are local assisters who are trained, certified, and required to provide fair, impartial, and accurate information.
- When shopping for health insurance, there are a number of factors to consider, including costs, networks of health care providers, and prescription drug coverage. Triage Cancer provides resources about Picking a Health Insurance Plan, including a Health Insurance Plan Comparison Worksheet and an animated video.
- Other Group Plan (Employee, Spouse, Parents, Schools, Associations, etc.)
Some people who are no longer eligible for Medicaid may be eligible for other forms of coverage besides a Marketplace plan, such as through a spouse’s job or their parent’s job.
You can contact the employer’s human resources department to get details about when and how you can enroll in the employer’s health plan. Plans often have SEPs for people who have lost other coverage, like Medicaid.
How You Can Help Spread the Word
You can help others in your family and in your community to not lose their Medicaid coverage by spreading the word. If people in your family have Medicaid, ask if they have gotten their paperwork, remind them to complete it, or ask if they need help sending it in. You can do the same with your neighbors, co-workers, members of your house of worship, or anyone else that you know.
For more information about Medicaid, visit our Medicaid Resources page.
About Triage Cancer
Triage Cancer is a national, nonprofit providing free education to people diagnosed with cancer, caregivers, and health care professionals on cancer-related legal and practical issues. Through events, materials, and resources, Triage Cancer is dedicated to helping people move beyond diagnosis.
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