Medicaid Redetermination:
When Will It Restart and What to Expect

medicaid The process of Medicaid redetermination has been on hold since March 2020 when the federal government declared a public health emergency (PHE) in response to the COVID–19 pandemic.

States were allowed to waive eligibility requirements for Medicaid to assist millions of Americans who lost their jobs, along with their employee-subsidized health insurance, as unemployment rose precipitously during the early months of the COVID crisis.

Since the onset of the pandemic, Medicaid has gained more than 14 million beneficiaries without the normal disenrollments that were routine prior to the pandemic.

Highmark Resources for Patients Facing a Disruption in Coverage

 Region  Number  Website
Western PA 888-234-5406 www.highmarkbcbs.com
Central PA 888-234-5406 www.highmarkblueshield.com
Delaware 888-234-5406 www.highmarkbcbsde.com
West Virginia 888-234-5406 www.highmarkbcbswv.com
Western New York 844-885-1004 www.mybcbswny.com/stateplans

The PHE was recently extended by the Department of Health and Human Services another 90 days from October 13, 2022, to January 11, 2023. The federal government will provide 60-days’ advance notice when it decides to terminate the PHE. This will help providers, Medicaid recipients, and insurance companies prepare for the adjustment period. If the PHE does conclude on January 11, 2023, then the advanced notification date will be November 12, 2022.

A Challenging Return to Normal

When the PHE ends, states will start reviewing the eligibility requirements of Medicaid beneficiaries, as they had done previously, and it is estimated that millions of current recipients will lose their Medicaid benefits as states revert to pre-pandemic protocols.

Since the Medicaid redetermination process hasn’t occurred in more than two years, it will be prudent to keep the following factors in mind:

  • There will be new enrollees who aren’t familiar with the process
  • Longer-term beneficiaries who may have forgotten how the process works
  • State agencies may be challenged by the increased demand for services

Information for Patients

Highmark has many insurance options for patients who are shopping for a new plan, including Affordable Care Act and Medicare Advantage options. Here are the customer service numbers and websites that will be helpful for your patients seeking to transition to a new Highmark insurance plan:

 Region  Number  Website
Western PA 888-234-5406 www.highmarkbcbs.com
Central PA 888-234-5406 www.highmarkblueshield.com
Delaware 888-234-5406 www.highmarkbcbsde.com
West Virginia 888-234-5406 www.highmarkbcbswv.com
Western New York 844-885-1004 www.mybcbswny.com/stateplans

For information about how the Centers for Medicare & Medicaid Services is preparing to assist states with the “unwinding” of the PHE, click here.

 

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