April 3, 2023

How to Help Patients Through Medicaid Redetermination

written by
Sanjay Basu
How to Help Patients Through Medicaid Redetermination

According to the Kaiser Family Foundation (KFF), as many as 15 million Americans are at risk of losing their Medicaid coverage with the end of the COVID-19 public health emergency (PHE). Many state Medicaid programs have recently announced plans to re-verify eligibility for their enrollees, per new federal requirements. This “Medicaid redetermination” process will involve contacting millions of enrollees to ensure they still qualify for coverage. 

For healthcare providers and advocates, here are some ways you can help your patients successfully navigate Medicaid redetermination:

  1. Educate patients about the redetermination process. Explain that they'll receive notices in the mail from their state Medicaid agency requesting documents to prove their income, family size, and other eligibility criteria. It’s important to warn patients that redetermination letters may look like bills or advertisements from their state or health plan. Reassure patients that they can continue using their benefits as usual during the process. 
  2. Offer to help patients with paperwork. For patients with literacy barriers or disabilities, offer to assist them in completing redetermination forms, providing requested documents, and writing exemption requests if needed. Medicaid redetermination typically requires proof of income, family size, and disability status. Help patients compile pay stubs, tax returns, birth certificates, and disability statements. 
  3. If a patient is no longer eligible for Medicaid coverage, help them apply early to the Health Insurance Marketplace. It's important for patients to know they can apply and enroll in a Marketplace plan as early as 60 days before their Medicaid or CHIP coverage ends. There are several ways to find local assistance for health insurance enrollment in the Marketplace. One way is to search the online directory at localhelp.healthcare.gov for a free public navigator service, which can help patients enroll in coverage through the Health Insurance Marketplace website
  4. Monitor for erroneous terminations. During processes like redetermination, mistakes can happen that result in people erroneously losing coverage. You can monitor your patients' cases and reach out to the state Medicaid agency on their behalf if you identify a termination made in error so coverage can be quickly reinstated.
  5. Direct patients to advocacy resources. Local legal aid organizations, healthcare advocacy groups, and disability rights centers may be able to provide additional help to patients struggling with the redetermination process. You can provide patients with referrals and contact information for resources in your area using findhelp.org.
  6. Request extensions when needed. If patients require more time to gather documents or complete the redetermination process, you can contact the state Medicaid agency on their behalf to request a reasonable extension. Explain any circumstances contributing to the delay to support the request for more time.

The Medicaid redetermination process can be challenging to navigate. At Waymark, our team of community health workers and care coordinators can help your practice provide education, assistance, advocacy, and extensions to help your patients maintain and secure, if needed, ongoing access to health coverage. We believe continuous Medicaid enrollment is crucial for promoting health access, stability, and continuity of care. With your support, patients will be better equipped to successfully complete the redetermination process.