Medicaid redetermination: What does that mean?
The Medicare markets today in the United States is continually growing. Medicaid grew by more than 30 percent from February to October in 2022.
The large reason for that was obviously the coronavirus. With COVID, we know that our government put us under a federal state of emergency, and they passed a bill called the Coronavirus Response Act.
What that essentially did was it allowed states to keep individuals on Medicaid through the pandemic. During that time, states were actually given a bonus, just over 6 percent bonus from what the federal funds allotted each state to keep individuals on Medicaid during the state of emergency.
During that time, states could not make it more difficult to enroll in their Medicaid programs, nor they could not change the enrollment process.
Up to 14 million people could lose Medicaid coverage once the continuous enrollment provision ends.
For that reason, for the last two plus years, there have been individuals that technically should have been removed from the Medicaid roles which have not been removed. There are a lot of people that are receiving those extra benefits they don't technically qualify for at this point.
Loss of Medicaid leads to Special Enrollment Period (SEP)
In December 2022, there was new legislation that was signed, and as of March 31 2023, there will become new Medicaid reevaluation processes. This will be a 14-month process, but states will now be reevaluating that, and statistics tell us that upwards of 14 million people nationwide could lose their Medicaid statuses.
What does that mean for you? It means that if you are currently working in the ACA market, there could be some really nice opportunities because those individuals that qualified for Medicaid obviously did not qualify for tax credits. Therefore, they were not candidates to write an ACA product for.
With the loss of Medicaid, that's going to create a special enrollment period for individuals to enroll into an ACA plan.
If you're not currently working in the ACA market, this could create a really good opportunity during this time of the year to enroll those individuals into an ACA product.
Medicare advantage market could grow with Medicaid redetermination
For those individuals that work in the Medicare markets, keep in mind we have a large demographic of individuals over the last couple of years who have qualified for partial DSNP products or full dual special needs plans that may very well be losing their benefits as well.
They will at least have Medicare to fall back in on if they don't do anything. However, we know that the risk with just having Medicare alone are far greater than what they would be in if they went with a Medicare Advantage product.
It is strongly encouraged that you look for those individuals that may be losing their Medicaid status on the Medicare side as well. We know that with Medicare, the demographic says that more and more people are aging into Medicare. We know that that market continues to be strong.
Medicaid Redetermination Letters
It is also encouraged that you let people know to be expecting redetermination letters that will be going out because they will start going out in many states as early as today; it's a 14-month process. It could be some time, depending on where you're located, that your consumers will get those letters.
Be prepared when clients call asking about loss of Medicaid coverage
Being prepared ahead of time with answers for those individuals when they call is the goal. When they get those letters, it then creates an opportunity for you, the agent, to be able to help them switch over from a Medicaid product to a Medicare Advantage product, or maybe a chronic special needs plan that they'll qualify for with the laws of Medicaid.
Keep in mind that every state is going to roll out under a different time frame, but all redeterminations must be made within the next 14 months.
Big opportunity to grow your book of business
It's going to be a process and not every state will work the same, but you're going to be getting calls from consumers. The time is now to be proactive with your clients.
It is suggested that you try to reach out to all individuals that were on dual special needs plans. It is key to educate them and let them know that the redeterminations are being done. They should know if they receive a letter letting them know that they no longer qualify for that special needs plan, that you do have other options for them. If you're working in the ACA markets, it may be a good opportunity for you maybe to reach out to some CPAs.
Reach back out your current block of business and let them know that if they have friends or relatives that have had Medicaid and receive notice; schedule a time to talk.
This can be a really good time for marketing purposes for agents. This time of the year is a little bit slower time of the year than during the annual enrollment period. It's going to create a buzz and create activity. Like a wise man once said, anytime the federal government gets involved in health care, there's an opportunity for us as agents; we should look for it.
Make sure to check out our website for any further advice on selling Medicaid in the ACA and Medicare markets.
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