‘It’s Finally Here’: States Have Long Sought Medicaid Eligibility Redetermination Deadline
The long-awaited Medicaid eligibility redetermination deadline is finally here. Medicaid is a critical component of health coverage in the United States, providing millions of people with access to health care and other needed services. To ensure the Medicaid program remains financially solvent, Congress has mandated that state Medicaid programs periodically review and update their Medicaid eligibility criteria. This periodic review process is known as “redetermination.”
What the Medicaid Redetermination Deadline Means for States
The new redetermination deadline means states have to review the eligibility status of all of their Medicaid enrollees on a timely basis. States must now complete the process of “redetermining” eligibility within 12 months from the date a person applied or was last found eligible. This means that if a state has not reviewed a person’s eligibility for Medicaid services in the past 12 months, it will do so now.
How States Can Meet the Deadline
States have various methods for ensuring they meet the redetermination deadline. Several states have adopted automated systems that use existing data sets and technologies to verify whether an individual is still eligible for Medicaid, reducing the burden of manual reviews and reducing the overall cost of conducting the eligibility redeterminations. Other states have contracted with third-party vendors to conduct the review and re-determination process.
The Impact of the Deadline
The redetermination deadline is important for both states and enrollees. States who fail to meet the deadline risk federal penalties, including the possible loss of fee-for-service payments associated with Medicaid services. Enrollees, on the other hand, benefit from more timely eligibility reviews, as they can more quickly access necessary healthcare services.
The Medicaid eligibility redetermination deadline is an important milestone for states and for Medicaid enrollees. States must take advantage of automated systems and other methods to ensure they meet the deadline and avoid federal sanctions, while enrolled individuals can benefit from timely eligibility reviews.
- The Medicaid redetermination deadline is 12 months from the date an individual applied or was last found eligible.
- States can use automated systems and third-party vendors to meet the deadline.
- States that fail to meet the deadline risk federal penalties, while enrollees benefit from more timely eligibility reviews.