AHCA/NCAL Member Resources on Medicaid Unwinding Now Available

Medicaid; Programs and Resources; COVID-19

Return to Regular Medicaid Redetermination: Ensuring Resident Medicaid Coverage

Since March 2020, states ceased Medicaid eligibility determinations and have been unable to disenroll any Medicaid beneficiaries from the Medicaid program. The freeze on redeterminations and prohibition on disenrollment were based upon federal statutory requirements states had to meet to receive the increased federal Medicaid funding of 6.2% over the course of the pandemic. Now with the Public Health Emergency (PHE) ending, states are returning to “regular” Medicaid redeterminations schedules. 

Why This Matters

States – State Medicaid Agencies have over 87 million redeterminations to conduct before May 2024. Since most states have not conducted redeterminations in over three years, beneficiary information has become out of date (contact information, financial information, etc.) and state agencies have had significant staff turnover and shortages. It is important for state and/or county eligibility units to have some staff familiar with redetermination.

Providers – If a beneficiary loses Medicaid eligibility, Medicaid payments stop, and beneficiaries have very clear protections in federal law for when these breaks occur despite the loss of Medicaid payments. Despite staff turnover in NF and AL business offices, providers need to ensure they have staff members with Medicaid redetermination experience.

AHCA/NCAL has prepared an array of resources on ahcancalED aimed at supporting members to manage significant numbers of Medicaid Redeterminations. Working with partner organizations, AHCA/NCAL has developed three modules and related tools.