Effective April 1, 2023, states have begun the redetermination process for Medicaid. Although each state has determined its own timeline for beginning this process, redeterminations must be complete by May 31, 2024.
How will the Medicaid Redetermination Process work? States have four general options in terms of how they handle the redetermination process:
- Population-based: Under this approach, a state will prioritize eligibility redeterminations for enrollees that the state believes are most likely to no longer be eligible for Medicaid. This would include, for example, people who were enrolled under Medicaid expansion but have since turned 65, and people who have reported an income increase during the PHE. Texas is an example of a state taking this approach.
- Time-based: Under this approach, a state will either prioritize enrollees whose renewals have been pended for the longest time during the PHE, or simply keep each enrollee’s existing renewal month. Virginia is an example of a state taking this approach.
- Hybrid: This is a combination of the population-based and time-based approaches. A state might initially prioritize redeterminations for certain enrollees who are considered most likely to be ineligible for Medicaid, and then use the time-based approach for the rest of its Medicaid population. Tennessee is an example of a state taking this approach.
- State-developed: This option allows states to create their own protocol for handling and prioritizing the eligibility redeterminations, but states are limited by various federal rules (for example, states cannot prioritize or deprioritize redeterminations based on the portion of the enrollees’ costs that are covered by the federal government, nor can states violate anti-discrimination laws). Georgia is an example of a state taking this approach.
You should check with your local Medicaid agency regarding its redetermination process. However, regardless of the approach that your state adopts, promptly respond to any request for information, termination, or notice of disenrollment. If you need assistance with specific questions, please feel free to reach out to us.