Medicaid Unwinding links for members

“Medicaid Unwinding” - Changes Coming in 2023

A Focus on Persons with Disabilities
During the COVID-19 public health emergency, states could not stop or reduce Medicaid coverage.  Now states must review all Medicaid cases to see if coverage should continue or if the Medicaid category and/or scope of coverage should change.  Medicaid changes can start April 1st, with some reviews occurring later in 2023.

One-Page Medicaid Unwinding Guide Available Here
Highlights what to tell beneficiaries, steps beneficiaries can take to protect Medicaid, and potential referral sources where beneficiaries can find help.

What Populations are at High Risk for Loss of Medicaid?
This includes persons with disabilities, persons with Limited English Proficiency (including recent immigrants), persons of color, Native Americans, and persons who moved one or more times during the pandemic.

Where Can I Learn More About Medicaid Unwinding?
What Life Changes May Have Positive or Negative Impacts on Medicaid Eligibility?
  • Youth turned 18 during pandemic, now eligible for SSI without counting parents’ income and resources. In most states this youth will be automatically eligible for Medicaid. 
  • Adult with Social Security Disability is now eligible for Medicare after 24-month waiting period. This may affect eligibility for some Medicaid categories or limit ability to get coverage through the Affordable Care Act (“Obamacare”) exchange. Screen for Medicare Savings Plan eligibility (see Deeper Dive article on members only section). 
  • SSI beneficiary is now working and is no longer eligible for SSI payments. Are they eligible for continued Medicaid through the 1619(b) work incentive?
  • Social Security Disability beneficiary, with no SSI, is now working. Are they eligible for Medicaid buy-in work incentive? Approximately 46 states now offer this optional Medicaid category, with persons able to retain Medicaid with earned income of more than $50,000 in some states.
  • Divorce, separation, or death of a spouse. The Medicaid beneficiary who remains in the household may now have eligibility determined without considering the spouse’s income and assets. Additionally, the absent spouse’s income will not be considered for SSI eligibility for a minor child.
  • Marriage during pandemic, or spouse is now working/earning more. If the new spouse has significant earned or unearned income, that may increase countable income for Medicaid purposes. If the state has the optional medically needy spend down (share of cost) Medicaid category, the person may still be eligible for Medicaid but with an increased spend down.
  • Other increase in income of the Medicaid beneficiary or another household member. Many persons became Medicaid eligible during the pandemic after they or a household member were laid off or had work hours reduced. If that person or household member is working again or earning more money, that could cause the person or family to lose Medicaid eligibility. Alternatively, if the state offers Medicaid where the beneficiary must contribute a share of cost (often called a “spend down”) that share of cost may now increase.
Should My Agency Consider an Outreach Strategy to Get the Word Out?
Options for outreach:
  • You/your agency develops a plan and implements
  • Find an agency or group already doing outreach. Offer to join them in some limited capacity, e.g., you could offer to provide training/materials on Medicaid buy-in as alternative Medicaid category.
  • Invite person(s) doing the outreach to speak at one or more of your events.
Funding your short-term outreach initiative:
  • Assume we are talking about funding amounts as low as $5,000 and up to $25,000.
  • Find entity already funded to do this and offer to assist if entity can cover costs.
  • Identify one or more funding sources for short-term grant: State agencies (e.g., mental health, developmental disabilities council), local not-for-profit (e.g., United Way), or private foundation. Some entities may be able to offer limited assistance without a rigorous application and review process.