Medicaid Insurers Brace for the Return of Eligibility Redeterminations

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.