Medicaid enrollment protections ending: How you can help your clients retain health insurance coverage

Special protections that kept people enrolled in Medicaid during the COVID-19 crisis ended on March 31, and millions of people could lose coverage as states resume regular eligibility checks after three years of guaranteed coverage. Early data from this process – known as the unwinding – suggests that many people who are losing coverage are still eligible.

What is the unwinding?

The unwinding refers to the return to normal Medicaid operations after the lifting of the continuous enrollment protections, which requires states to conduct eligibility checks for all Medicaid enrollees and remove those whose continuing eligibility cannot be verified. More than 93 million people were enrolled in Medicaid or Children’s Health Insurance Programs (CHIP) before the unwinding began.

Forty-one states had restarted disenrollments as of June 1. States can take as long as 12 months to start renewals for all their enrollees, and an additional two months to complete them.

Find out when your state will start renewals and terminations on the Medicaid website.

Who could lose coverage?

Between 8 and 24 million people could be purged from the rolls during the unwinding period, according to one analysis. In some cases, the state will be able to show that a person is no longer eligible because of a change in income or other circumstances. Many of these consumers will qualify for zero- or low-premium coverage from HealthCare.gov or a state-based Marketplace.

But other people will lose coverage because the state does not know if they are still eligible – these are called procedural terminations, and they could happen because a person did not receive the renewal form in the mail, didn’t return the form on time, or couldn’t get through to a call center for help. In several states the share of procedural disenrollments was over 80% in the first months of the unwinding.

It is possible that occupational therapy clients who lose Medicaid coverage will not know it until they come in for an appointment. A recent survey found that more than 70% of enrollees did not realize that states were about to start removing people from Medicaid (they were either “not sure” if states could take away their coverage or believed that states were not allowed to do so).

How can OT practitioners help minimize coverage loss?

OT practitioners can help minimize coverage loss by encouraging clients who rely on Medicaid to take these steps:

• Update your contact information. Make sure the state Medicaid agency knows your current mailing address, phone number, and email address so they can contact you with important information about your health insurance.
• Get ready to renew your coverage. Medicaid is restarting regular eligibility checks. Be on the lookout for letters, emails, calls, or text messages from Medicaid, and respond quickly to requests for information. Parents should complete the form even if you think you are no longer eligible, because your children might still qualify – eligibility levels for adults and kids usually differ.
• Know your options if you are no longer eligible. You may be able to get zero- or low-premium health insurance from the ACA Marketplace at HealthCare.gov. You can apply right away: If you lose Medicaid or CHIP coverage between March 31, 2023 and July 31, 2024, you will be eligible for a special enrollment period. Kids may be eligible for CHIP.

What else can OT practitioners do?

• Tell your clients about other sources of coverage like HealthCare.gov, explain that they can reapply if their coverage is ended for procedural reasons, and inform them of their right to appeal if they are wrongfully terminated for eligibility reasons.
• Warn your clients about Medicaid unwinding scams. Medicaid enrollees should never share their social security number or credit card information with anyone who contacts them and demands payment to keep their Medicaid coverage. The state Medicaid agency will never threaten beneficiaries with legal action if they do not share that information.
• Hold your state accountable. If you see a pattern of coverage loss disrupting your clients’ care, let officials know so they can take corrective action. You can also share this information with your state association and the AOTA State Affairs team at state@aota.org.

Where can I find more resources?

The Medicaid and CHIP Beneficiary Resource Page has plain language information about the unwinding and links to state Medicaid offices and the Marketplace.

States have publicly available resources like unwinding plans or summaries, provider toolkits, and data dashboards to track changes in enrollment.

The Centers for Medicare and Medicaid Services (CMS) Unwinding and Returning to Regular Operations After COVID-19 page has an array of resources including state guidance and messaging toolkits.