Medicaid Insurers Brace for the Return of Eligibility Redeterminations

  • Feb 10, 2023

    Medicaid managed care organizations (MCOs) face a daunting challenge this year as the safety-net insurance program is poised to resume eligibility checks that had been suspended during the COVID-19 public health emergency (PHE). Insurers tell AIS Health, a division of MMIT, that they are taking proactive steps to manage redeterminations, including coordinating with providers, liaising with state agencies and stepping up member contacts to ensure that beneficiaries don’t lose coverage unnecessarily. 

    During most of the COVID-19 pandemic, Medicaid did not check on beneficiaries to see whether they were eligible for enrollment. That’s because, throughout the COVID-19 PHE, states have received a 6.2 percentage-point increase in Medicaid funding — known as the Federal Medical Assistance Percentage (FMAP) — in exchange for maintaining continuous enrollment of nearly all Medicaid enrollees. Medicaid normally requires members to periodically document their income and demonstrate that they don’t earn more than Medicaid beneficiaries are allowed to make. 

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  • Peter Johnson

    Peter has worked as a journalist since 2011 and has covered health care since 2020. At AIS Health, Peter covers trends in finance, business and policy that affect the health insurance and pharma sectors. For Health Plan Weekly, he covers all aspects of the U.S. health insurance sector, including employer-sponsored insurance, Medicaid managed care, Medicare Advantage and the Affordable Care Act individual marketplaces. In Radar on Drug Benefits, Peter covers the operations of (and conflicts between) pharmacy benefit managers and pharmaceutical manufacturers, with a particular focus on pricing dynamics and market access. Before joining AIS Health, Peter covered transportation, public safety and local government for various outlets in Seattle, his hometown and current place of residence. He graduated with a B.A. from Colby College.

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