Millions on Medicaid May Lose Coverage with New NY Mandates

This article is not intended to provide you with legal advice. Should you seek legal advice, please consult an attorney. KTS would gladly recommend an attorney should you need one. It’s important to have an attorney take appropriate actions on your behalf and to avoid issues that may be discussed in this article.

The last three years have been a challenge for most people. To make healthcare coverage easier for low-income individuals and families during this time, the Families First Coronavirus Response Act (FFCRA) allowed Medicaid enrollees to simply sign a form attesting that their income and assets were below the required limit. This special enrollment period allowed the enrollees to benefit from the Medicaid health insurance program with minimal delay.

The intent was for states to provide continuous coverage and more flexibility for Medicaid enrollees in the enrollment and re-enrollment process during the public health emergency (PHE). These relaxed requirements were in place for those who began coverage during the pandemic (in or after March 2020). State’s Medicaid programs, for example, waived income verification, allowing Medicaid recipients to focus on and deal with pandemic issues and procedures.

Why is there a change in the enrollment process?

Since February 2020, as the pandemic began, the number of people enrolling in Medicaid has increased. Growing close to 95 million in March 2023 from 23.3 million (February 2020), the “continuous enrollment provision” within the FFCRA stopped disenrollment of Medicaid recipients and their coverage. This provision kept individuals and families covered without interruption during the pandemic as states were prevented from disenrolling recipients to maintain the “enhanced federal funding.”

But as we move past the pandemic, due to President Biden’s official ending of the National Public Health Emergency Declaration on May 11, 2023, the standard documentation requirements have been reinstated. 

Therefore, after March 31, 2023, with the end of the public health emergency, states have resumed the standard Medicaid documentation requirements for enrollment and eligibility. In other words, with the public health emergency behind us, procedures for Medicaid enrollment and re-enrollment are reverting back to the standard requirements. So, there may be people who lose Medicaid coverage if they are unable to verify their income within the required limits.

When will the Medicaid enrollment changes begin?

Beginning on April 1st 2023, states are allowed to stop continuous enrollment. This means states will begin the process of disenrolling people from Medicaid who are no longer eligible. They will, therefore, begin resuming the standard “full eligibility redeterminations,” which will affect millions of recipients who are no longer eligible to receive Medicaid coverage.

The initiation of eligibility redetermination standards must begin within 12 months and be completed within 14 months beginning with April 2023 Medicaid enrollees. New York’s plan to reinstate the standard enrollment process began in Spring 2023 by resuming reviews for eligibility and renewing enrollments for those currently enrolled in Medicaid.

Renewals in New York will continue to follow NY Medicaid enrollees’ current renewal dates and will send notifications a month prior. Since the continued coverage provision ceased in April 2023, renewal notices began in March 2023. New York’s first group of disenrollments began in July 2023. 

What can you expect to occur as a Medicaid recipient?

Each state’s approach to this winding down of automatic and continuous enrollments may vary. So, it’s important to check with your specific state as soon as possible for how you will be affected and the next steps to take to prevent a disruption in health coverage. 

While the process of continuous enrollment is being discontinued, states cannot increase premiums, restrict eligibility standards, procedures, and methodologies. States are required to comply with federal rules regarding enrollments. 

Who will be affected by this updated/resumed documentation requirement?

New York state has more than 7.9 Medicaid enrollees whose renewals must be completed by May 2024. Approximately, 40% are expected to be “ex parte renewed” or without needing to provide certain documentation. That leaves another 60% for whom Medicaid renewal may be in jeopardy.

This group will be required to prove their eligibility by providing the required documentation, including proof of income, citizenship/immigration, Medicare, etc. Without appropriate documentation, they would lose their Medicaid eligibility.

So, if you are currently a Medicaid recipient in the state of New York, you’ll want to be prepared in order to ensure a smooth renewal process and/or to be sure you receive continued health coverage. 

How can I prepare for the changes in New York as a Medicaid enrollee?

Now that the renewal process has begun for Medicaid recipients, it’s important to be sure that New York State of Health has your correct contact information by calling 1-855-355-5777 (TTY: 1-800-662-1220) or visiting nystateofhealth.ny.gov. 

Be sure to watch your mail for upcoming communication from NY State of Health or your local Medicaid office or county’s Local Department of Social Services. Follow instructions promptly and respond with additional information if requested. Check for other suggestions on the NY State of Health website. 

What if I’m no longer eligible for Medicaid?

Should you find yourself no longer eligible for Medicaid, learn more about your health coverage options including Medicare or employer-sponsored insurance coverage. You may also be eligible for New York’s Essential Plan for those with household income up to 200% of the poverty level. In addition, this program is expected to cover more people in 2024 through an expansion plan to cover those with income up to 250% of the poverty level with a nominal monthly premium.

Get help with Medicaid planning.

For those who are looking to apply for Medicaid but may have excess income that may prevent them from receiving coverage, consider Medicaid planning. For example, you may not know that there are ways to gain eligibility for benefits through a pooled income trust. 

It’s a good idea to learn the value of Medicaid planning and how it can actually save you time and money. By finding a Medicaid planner, you’ll get assistance on how to plan if you are elderly or disabled, plus when and how to apply. 

A planner’s knowledge of Medicaid’s look-back period and laws provide information on how best to manage your finances in order to qualify for Medicaid. For example, how does owning a home affect eligibility? What assets can you hold and still qualify for Medicaid coverage? 

Find out how KTS Pooled Trust and Medicaid planning can help you. Or contact an attorney who specializes in elderly care law.

About the author, Carlos Nath:

Carlos Nath is the Senior Trust Advisor with KTS Pooled Trust. As a seasoned professional with over four years of experience in the New York pooled trust space, Carlos has helped thousands to enroll and set up their accounts with KTS. He is proficient in understanding the Medicare process and provides assistance in clarifying what clients may need. Previously, Carlos worked with a Medicaid consulting firm as an advisor who helped clients who were seeking Medicaid assistance.