If you’ve received notification that you’re losing Medicaid eligibility, you’re certainly not alone. Millions of Americans will get similar notices in 2023 and 2024, now that states are once again disenrolling people from Medicaid after not doing so between March 2020 and March 2023.
(If you need help to understand why you lost Medicaid, how to avoid loss of coverage or appeal lost coverage, please visit our article explaining Medicaid redeterminations.)
But that doesn’t make it any easier to find out your health coverage is ending. You’re still left with a big question: What to do now that you’ve been declared ineligible for Medicaid and dropped from the program? Let’s take a look.
Yes. Enrollment is open year-round, which means you can reapply for Medicaid anytime. So if your circumstances change and you think you once again meet the eligibility criteria (perhaps you experienced a pay cut or job loss), file a new application.
If you ended up losing Medicaid eligibility because you didn’t complete the renewal process, you have a 90-day window when you can get your coverage reinstated if you complete the renewal and are determined eligible.
If you’re losing Medicaid and are eligible for a plan from your employer or your spouse’s employer, you’ll be able to enroll in that plan. You also have the option to enroll in a plan offered through the Marketplace/exchange in your state. Here’s what you need to know about these coverage options:
If you became eligible for Medicare during the pandemic but didn’t enroll because your Medicaid didn’t end due to the continuous coverage rule, you’ll have a six-month window when you can transition to Medicare without a late-enrollment penalty. Here’s more about transitioning from expanded Medicaid to Medicare.
It’s important to understand that the rules have changed in recent years to make health coverage more affordable for more people. This includes larger and more widely available subsidies for Marketplace coverage, and a fix for the “family glitch” that makes some employees’ family members newly eligible for Marketplace subsidies.
So it’s very unusual for a person who isn’t eligible for Medicaid (or Medicare) to also be unable to find health insurance deemed affordable. But there are some exceptions, including very low-income adults in states that haven’t expanded Medicaid, as well as people who are ineligible to use the Marketplace because they’re not lawfully present in the U.S.
There are also various medical providers throughout the U.S. that can be used by people who don’t have health insurance, including federally qualified health centers, safety net hospitals, and free or sliding-scale clinics.
To some extent, yes. If you’ve been notified you are ineligible for Medicaid, there are several things to keep in mind in terms of how coverage options vary from state to state:
The rules for transitioning from Medicaid to an employer-sponsored plan are the same in every state. If you’re transitioning from Medicaid to Medicare, the rules are generally the same nationwide, but there’s state-to-state variation in terms of Medigap access if you’re under 65 or eligible for Medicare due to a disability.
Even if you’re no longer eligible for Medicaid, your child still may be eligible for Medicaid or the Children’s Health Insurance Program (CHIP). In every state, children can access these programs with higher household income levels than adults. So your ineligibility does not necessarily translate to your entire household.
If your kids are not eligible for Medicaid or CHIP, you may be able to secure coverage for them through an employer or the Marketplace under the same terms discussed above.
The state will process your renewal when it’s due and definitively determine your eligibility. But if you want to get a rough idea of your eligibility ahead of time, this chart shows Medicaid and CHIP income limits (as a percentage of the poverty level) in each state for children, pregnant women, parents of minor children, and adults under age 65.
And this chart shows the dollar amounts that correspond to various percentages of the poverty level in 2023. Note that the amounts vary depending on how many people are in your household.
If you’re 65 or older, or eligible for Medicaid due to a disability or blindness, your eligibility in most states depends on both income and assets.
Louise Norris is an independent individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.
