Medicaid Resumes Eligibility Reviews

The Medicaid website | Image by Tada Images/Shutterstock

The Texas Health and Human Services Commission (HHSC) is resuming Medicaid eligibility redeterminations after they were suspended during the COVID-19 pandemic. These redeterminations affected about 5.9 million recipients, the organization announced in a press release on April 3.

As part of its COVID-19 relief legislation passed in March 2020, Congress provided increased funding to the states for Medicaid coverage while stipulating that the states could not discontinue an enrollee’s coverage, in most instances, until after the declared public health emergency ended. Medicaid agencies could not disenroll anyone from the program unless they requested it, moved out of the state, or died.

By federal law, the continuous enrollment provision ended on March 31 of this year, and the enhanced federal funding will be phased out by the end of 2023. The HHSC is publicizing the end of the continuous coverage provision through social media, online banner messages, emails, flyers, and texts.

Government guidelines require that states conduct renewal determinations for all Medicaid participants over a period of 12 months. The HHSC plans to stagger the Medicaid redeterminations over the next several months, beginning with those recipients who are most likely to no longer qualify.

The HHSC will notify enrollees by mail or electronically when it is their turn to renew. Beginning in April, the agency will send renewal notices in a bright yellow envelope printed with “Action Required” in red letters.

Officials recommend that participants in this program be ready for these redeterminations.

“We urge Medicaid recipients to update their information and to be on the lookout for renewal notices,” said HHS Executive Commissioner Cecile Erwin Young, according to a press release. “We are committed to redetermining eligibility for our clients as quickly as possible and to continue services to those who still qualify,” she continued.

The HHSC also urged recipients to respond to distributed renewal packets or information requests promptly to prevent gaps in coverage. Those who respond within 30 days of receiving renewal packets or information requests will see their coverage continue until their redeterminations are completed.

During the eligibility redetermination, HHSC agents will also evaluate whether the Medicaid recipient qualifies for any other HHSC healthcare programs, such as Healthy Texas Women or the Children’s Health Insurance Program. Recipients will be informed if they are ineligible for continued Medicaid coverage and must be moved to a health program.

For enrollees who no longer qualify for any HHSC medical coverage, the agency will send their applications directly to the federal Health Insurance Marketplace.

The Texas HHSC announced that it had increased its staffing and onboarded 1,000 eligibility officers to complete this task.

“HHSC has increased its eligibility workforce through various recruitment and retention efforts, including hiring temporary staff to assist with the workload, implementing merit pay and salary adjustments, promoting flexible work schedules, and streamlining training requirements,” the organization stated in a press release.

HHSC officials expect to complete the redetermination process by May 2024.

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