Medicaid Will Be Checking Your Eligibility Soon: What Cancer Patients Should Know About Changing Coverage

This is the first time in three years state governments are checking Medicaid eligibility, and as many as 14 million people could lose coverage. If you go back to 2020, when the COVID-19 pandemic was in full force, the federal government told states not to throw participants out of Medicaid, even if their eligibility changed.

Keep in mind that before the pandemic, it was fairly common for folks to lose their Medicaid coverage if their eligibility changed, such as because of an increase in income, receiving other health insurance from an employer or spouse, or because they moved to another state. Now, three years after the start of the pandemic, Medicaid's stricter regulations and requirements are returning to normal.

When and How Will They Check Eligibility?

Over the next 12 months, states are set to review the eligibility of every single person who is on Medicaid.  States will be mailing a renewal form to your home, and some states may also have the option for you to complete an online form. The federal government is also requiring states to contact you by phone, text and email. You'll then have 30 days to complete the necessary forms and documentation.

If you don't meet the requirements, which include income and resource eligibility, you'll be removed from the program. Notices of acceptance or termination will go out through the mail, email and via text.

How Do I Know If I Still Qualify for Medicaid?

Eligibility is based on something called Modified Adjusted Gross Income (MAGI). MAGI is used to determine financial eligibility for Medicaid, as well as other federal healthcare programs. This is part of the Affordable Care Act, which promoted the use of one set of income counting rules, and a single application, in order to make it easier for people to apply and enroll in the appropriate program. Income levels that qualify for Medicaid vary state-by-state. That said, most states and Washington, D.C. have the same income limit for most types of Medicaid services:

• $2,523 per month for a single person
• $5,046 for a married couple, in most cases.

Other eligibility requirements for Medicaid include:

• Being a resident of the state in which you are receiving Medicaid
• Being a citizen of the U.S. or a qualified non-citizen (like a lawful permanent resident)
• Some eligibility groups may be limited by age, or pregnancy or parenting status

To help you get an idea if you still qualify for Medicaid coverage, as well as other health insurance options, you can take a quick screening on HealthCare.gov.

When Will I Find Out If I Still Qualify?

On average, the verification process for Medicaid is expected take anywhere from nine months to a year. That said, it depends on the state where you live. Some states are moving quickly, such as, Arizona, Arkansas, Florida, Idaho, Iowa, New Hampshire, Ohio, Oklahoma and West Virginia. They may start taking ineligible recipients off Medicaid as soon as April 2013.

Who Will Decide If I Qualify?

States will be making the decisions for their residents enrolled in Medicaid, and their exact eligibility and income requirements may vary. That said, federal law requires states to cover certain groups and individuals. Those groups include:

• Low-income families
• Qualified pregnant women and children
• Individuals receiving Supplemental Security Income (SSI)

What Should I Do Now?

While you may have a lot of other responsibilities during your cancer journey, it will be important to be on the look-out for notices to confirm your Medicaid eligibility. Make sure your information is all up-to-date and accurate. If the form isn't completed and submitted in time, states can automatically remove you from the Medicaid program.

What If I Lose My Medicaid Coverage?

It's understandable to feel anxious when you may suddenly lose the healthcare program you know and rely on. This is especially difficult if you're already dealing with your cancer diagnosis and treatments but try not to panic. Keep in mind that most folks who no longer qualify for Medicaid can still find affordable health care coverage through the Affordable Care Act's Marketplace. Depending on your income, your family's situation and any other serious health issues, you may be able to find a plan with low costs in your state. The Marketplace can help show you available plans in your state when you enter the zip code where you live.

Special Enrollment for Marketplace Coverage

There will be a special enrollment period for Marketplace coverage from March 31, 2023, to July 31, 2024. Folks who are looking to enroll in a new insurance program will have up to 60 days to sign up after losing their Medicaid coverage.

It’s important to note that, unfortunately, you might not be able to replicate the exact benefits you received from Medicaid. For example, it may mean that your out-of-pocket expenses and co-pays could be higher. Also, some options might not allow you to cover your personal doctors. So, before signing up for a particular plan, be sure to read the fine print.

If I'm Kicked Out of Medicaid, When Will My Coverage End?

Medicaid coverage usually stops at the end of the month when you’re no longer eligible for coverage. It's important for you to check with your state to find the exact start and end date for coverage for you and your family.

If there is a gap between the end of your Medicaid coverage and signing up for your new health plan, you may be able to qualify for retroactive coverage of medical expenses you incurred after losing Medicaid.

Will I Still Have Cancer Care Coverage With My New Health Insurance?

Don't worry, the Marketplace offers coverage to those who need it. The ACA requires that every health plan sold in the health insurance marketplaces covers certain essential benefits needed to prevent and treat a serious condition, such as cancer. For example:

• If you have a pre-existing condition such as cancer or another chronic illness and are purchasing a new plan, health insurance companies can't refuse to cover you. And they can't charge you more because you have a pre-existing condition.
• The ACA offers several safeguards to help make sure patients can choose the type of care they need. It requires private health plans to offer consumers information that is easy to understand about their coverage. It also encourages competition among the different insurance companies. In addition, it helps the consumer make more informed choices about which plan is best for their circumstances. People are given the opportunity to choose a plan either during a set open enrollment period or during a special enrollment period.

Can I Get Help Paying for My New Health Plan?

You may be eligible for ACA subsidies if you earn between $13,590 and $54,360 as an individual, or between $27,750 and $111,000 for a family of four. For most people, health insurance subsidies are also available if your income is between 100% to 400% of the federal poverty level (FPL).

Still, some cancer care that was covered under your Medicaid plan may not be covered with your new plan. This might include home healthcare, transportation and some rehabilitation services. While federally approved or funded clinical trials are usually approved, it's unlikely experimental treatments will be. https://content.naic.org/sites/default/files/publication-cax-pp-consumer-cancer.pdf

Learn more about SurvivorNet's rigorous medical review process.

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