New Hampshire and Pennsylvania Have Resumed Medicaid Redetermination

New Hampshire and Pennsylvania resumed their redetermination process for current Medicaid members February 1, 2023.

The Families First Coronavirus Response Act (FFCRA) provided states with additional Medicaid funding. To receive additional funding, a state was required to pause all Medicaid disenrollment.

The pause on Medicaid disenrollment is now ending and states will resume Medicaid redeterminations of eligibility and disenrollment of those determined to be ineligible for Medicaid coverage.

Loss of eligibility for Medicaid is a Qualifying Event for Special Enrollment on the Marketplace.* Many of these individuals could be eligible for financial assistance on the Marketplace and will need enrollment assistance from a broker.

Medicaid Redetermination Process

1. States must first attempt to predetermined eligibility based on available data sources before contacting the beneficiary.
2. If information is sufficient to renew eligibility, the agency notifies the beneficiary. The beneficiary doesn't need to sign & return the notice if the information is accurate.
3. If information is not sufficient to determine eligibility, the agency sends a pre-populated renewal form & requests additional information from the beneficiary.***
4. The agency is required to provide the beneficiary with 30 days to respond with requesting information.

***Some states are not required to send pre-populated forms to non-MAGI population.

Ambetter has put together a Medicaid Redetermination Resource Center for important updates and state-specific resources. Check it out!

View Resource Center

If you have any questions, call us today at 866-568-9649!