Maybe you’ve noticed that Medicaid has been in the news a lot lately as continuous coverage under the COVID Public Health Emergency (PHE) comes to an end. Let’s take a quick look at what that means.  

Medicaid redeterminations refer to the process of reviewing and updating a person’s eligibility for Medicaid coverage. This review is typically conducted on an annual basis, or more frequently, if necessary, to ensure that the person continues to meet the criteria for Medicaid, including income, citizenship, and other relevant factors.  

The redetermination process involves verifying information about the individual’s circumstances and comparing it to the Medicaid eligibility criteria. This may involve obtaining additional documentation, such as tax returns, pay stubs, or proof of residency. The results of the redetermination are then used to determine if the person remains eligible for Medicaid, if their coverage needs to be adjusted, or if their coverage needs to be terminated. 

The goal of the Medicaid redetermination process is to ensure that only those who are eligible receive Medicaid benefits and that those benefits are accurately tailored to meet the individual’s needs. This helps to ensure the integrity of the Medicaid program and prevent waste, fraud, and abuse. These redeterminations were put on hold under the PHE. Now, as the Public Health Emergency begins to unwind after three years, states must begin redeterminations by April 1.