Understanding Medicaid Renewals: Process, Frequency & Your Responsibilities

Last updated: April 17, 2024


 End of Covid Public Health Emergency: All Medicaid redeterminations were on hold during the Covid-19 Public Health Emergency (PHE). The PHE ended on May 11, 2023, and states were able to resume Medicaid redeterminations on April 1, 2023. Persons who are no longer eligible for Medicaid were / are being disenrolled. This is called “Medicaid Unwinding”.

What is Medicaid Renewal and How Often Does it Occur?

Medicaid Renewal, also called Medicaid Redetermination or Medicaid Recertification, is a necessary part of being a Medicaid beneficiary. This is true regardless of if one receives Regular State Plan benefits, long-term home and community based services (HCBS) via a Medicaid Waiver, or are on Nursing Home Medicaid. The redetermination process ensures one is still eligible to receive Medicaid benefits, and in the case of many seniors and persons with disabilities, continue to receive Medicaid-funded long-term services and supports. Medicaid has income and asset (resource) limits for elderly recipients and the Medicaid agency wants to ensure that the individual continues to fall under those financial limits.

 Most states require Medicaid beneficiaries to report any change in income or assets within 10 to 30 days.

Medicaid beneficiaries must report any change in income or assets, even if it is not time for renewal of Medicaid benefits. This is because circumstances, such as an increase in income or an inheritance, can cause one to be ineligible for Medicaid. Most states allow between 10 and 30 days to report any such changes. When the Medicaid agency receives the new information, they will determine if the beneficiary is still Medicaid-eligible. Failure to report changes can result in the loss of Medicaid benefits, repayment of services / benefits for which Medicaid paid, fines, and even jail time.

Medicaid Renewal for seniors and individuals with disabilities must occur at least every 12 months. A state may choose do redeterminations more frequently, but generally speaking, Medicaid Redetermination is limited to once a year.


What Does the Medicaid Agency Do During Renewal?

During Medicaid Renewal, the Medicaid agency checks to ensure eligibility criteria that are subject to change are still within the eligibility thresholds. Specifically, monthly income and countable assets are checked to make sure they are still under the limits. Medicaid will also check to ensure assets did not exceed the asset limit at any point during the year.

In practical terms, this means the Medicaid agency will review bank accounts, taxes, income, pension statements, the equity value of one’s home, and any other financial documents that were reviewed during the initial Medicaid application. California is an exception and does not check a Medicaid recipient’s assets. Effective 1/1/24, the state eliminated their asset limit.

For Medicaid beneficiaries who are nursing home residents or receive home and community based services via a Medicaid Waiver, their spouse’s income and assets are not considered in their redetermination of Medicaid eligibility.

Some information that was provided at initial application does not have to reverified. This includes one’s age, Social Security number, and citizenship.


What is Required of the Medicaid Beneficiary During Renewal?

In some states and situations, a Medicaid beneficiary may not have to do anything during the renewal process. The Medicaid agency may be able to process the entire Medicaid Renewal electronically without requesting any documentation from the Medicaid recipient. In other states and cases, the senior Medicaid recipient may have to complete a redetermination form, either via paper, online, or in person. Proof of income or resources may be requested.

Proof of income may include copies of alimony checks, SSI or VA benefit award letters, tax forms, and pension statements. A letter of self-declaration of income may be acceptable when there is no other way to prove income.

Requested documentation related to proof of resources might include statements from checking / savings accounts, certificates of deposit, money market accounts, stocks, bonds, and retirement accounts. The cash surrender value of life insurance policies may also be considered, and therefore, copies of life insurance policies might be requested. If equity value in one’s home or car has changed, documentation may also be required.


How Does the Medicaid Renewal Process Work?

The Medicaid Renewal process is not consistent across all states and Medicaid groups. Below are the federal regulations that govern Medicaid Renewals. States do not have to comply to this redetermination process in its entirety when determining continued eligibility for persons who are elderly. Therefore, this is a rough guideline as to how the renewal process might work.

Automatic Renewal
For redetermination of benefits, states are required to utilize available electronic data sources to determine if the Medicaid beneficiary still meets the eligibility criteria. If it is determined that the individual is still eligible for benefits, the state must “automatically renew” that individual’s coverage without requesting any information from them. This process is also called an Ex Parte Renewal, Administrative Renewal, or Automated Renewal.

Automated Renewal is not always possible. In some situations, the Medicaid recipient’s income and / or assets may not be able to be verified electronically. As an example, rental income and self-employment income are two types of income that cannot be verified via electronic databases. In the case where electronic sources indicate that a recipient’s income is over the income limit, Medicaid Renewal cannot be automatically extended. Furthermore, if a recipient does not have a Social Security number, electronic databases will be of no use for verification of eligibility information. Paper documentation can only be requested by a state Medicaid agency if redetermination cannot be determined electronically.

Pre-Populated Renewal Form
If a Medicaid recipient’s continuing eligibility cannot be determined via Automatic Renewal, the state may send out a pre-populated form. This means that the state will fill in the information in which it already knows about the recipient, such as their name and the names of the other persons living in the household, and only the information unknown to the Medicaid agency will have to be provided. If any of the pre-populated information is incorrect, it must be corrected.

States are only required to send a pre-populated form to specific eligibility groups. This includes those within the MAGI (Modified Adjusted Gross Income) group, such as adults between the ages of 19 and 64 without children, pregnant women, and parents / caretaker relatives. For seniors who are aged 65 years and over, persons receiving long-term home and community based services, SSI recipients, and persons in Medicaid-funded nursing homes, sending a pre-populated renewal form is optional. If a state cannot renew a beneficiary’s Medicaid eligibility automatically, a renewal form, pre-populated or not, will be sent to the Medicaid recipient.

The completed renewal form must be signed, dated, and returned to the Medicaid agency. The recipient is also instructed to provide any required documentation, such as proof of income and assets, along with the redetermination form. The beneficiary must be given a minimum of 30 days to do so. Alternatively, persons may be able to do their Medicaid Redetermination online, via phone, or in person at one’s local Medicaid agency.


Does the Renewal Process Differ By State or Specific Medicaid Program?

Yes, the redetermination process varies based on the state and the Medicaid program in which one is enrolled. For instance, there are many different Medicaid eligibility groups, such as children, adults under age 65, parents and caretaker relatives, pregnant women, SSI-eligible persons, seniors aged 65+, aged and persons with disabilities that require long-term services and supports, and individuals that require nursing home care. Essentially, these groups are broken down into two categories: MAGI (Modified Adjusted Gross Income) and non-MAGI.

The MAGI group consists of children who are under the age of 19, pregnant women, parents and caregiver relatives, and adults without children who are between the ages of 19 and 64. The non-MAGI group, which is relevant for elderly individuals, includes SSI recipients, aged, blind and disabled individuals, persons receiving home and community based Waiver services, and those receiving long term care services, such as nursing home care.

The Affordable Care Act (ACA) streamlined the redetermination process for the MAGI group throughout the states. These federal regulations are not necessarily required for individuals who are elderly or have physical disabilities.


What Happens When You Don’t Renew in Time?

  Failure to renew can result in loss of benefits.

If a Medicaid beneficiary does not complete the redetermination process in time, Medicaid benefits will cease and there will be a lack of coverage. Under federal law, the individual has 90 days from the date in which the case was closed to provide the Medicaid agency with all of the required information. In this case, Medicaid benefits can be reinstated without the individual going through the application process again if they continue to meet the eligibility criteria. Medicaid coverage in some states is retroactive. This means any accrued medical bills during the lapse in coverage that are generally covered by Medicaid will be covered. If one does not submit the necessary documentation and complete the redetermination process within the 90 day period, they have to reapply for Medicaid benefits and a gap in benefits is very likely to occur.


Assistance with Medicaid Renewals

 Public assistance for renewals is only available if the beneficiary continues to meet the eligibility requirements.

Public Benefits Counselors or Case Managers can be a great help during the redetermination process. These professionals commonly work at state Medicaid agencies, Aging and Disability Resource Centers, and Area Agencies on Aging and provide free assistance with filling out a renewal form and gathering and submitting required documentation. However, if a Medicaid recipient no longer meets the eligibility criteria, a Public Benefits Counselor cannot assist. For example, if the beneficiary received an inheritance and has assets valued above the Medicaid limit, they will not receive assistance from a Public Benefits Counselor. This also occurs commonly when a home has increased in value and exceeds the exemption, if the persons residing in the home have changed, or if an “Intent to Return” home has expired or been overruled.

Private assistance is available for these situations. Certified Medicaid Planners and some Elder Law Attorneys provide Medicaid Redetermination services for a minor annual fee. This is especially true if the provider helped the beneficiary with their original Medicaid application. Depending on the state and the complexity of the renewal / redetermination process, fees are usually $1,500 – $3,000. One can connect with a Medicaid Planning Professional that provides renewal services. The linked form is intended for first-time Medicaid applicants, but will also work to connect beneficiaries with renewal service providers.

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