Protecting Medicaid Coverage for Virginians in 2023
Below are answers to some frequently asked questions about the process of Medicaid “unwinding” and return to normal renewal processes for Medicaid and FAMIS enrollees. This page also contains outreach materials and additional resources for health advocates and community partners.
Medicaid enrollees seeking information about their coverage should visit enrollva.org/medicaid-renewals or contact a navigator.
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Frequently Asked Questions (FAQs)
In March 2020, the federal government prohibited states from terminating or reducing health coverage for Medicaid and CHIP enrollees for the duration of the federal COVID-19 public health emergency (PHE), with few exceptions. This provision is referred to as the “Medicaid continuous coverage requirement.” While the requirement was in place, Medicaid enrollees did not need to renew their coverage or report changes in income or other eligibility criteria. They could not lose coverage if their household went over the Medicaid income limit or if they aged into Medicare, among other reasons.
However, the federal government decoupled the Medicaid continuous coverage requirement from the PHE in a change effective March 31, 2023, which triggers the process of Medicaid “unwinding.”
Now that the continuous coverage requirement has ended, Virginia must resume normal Medicaid eligibility and renewal operations — including redetermining eligibility for all overdue cases (cases where eligibility has not been confirmed within the past 12 months) and resuming annual renewal procedures. This process is often called “unwinding.” The federal government has given states 12 months to initiate redeterminations for all overdue cases, and 14 months to complete them. Virginia plans to use this full period and spread out renewals as evenly as possible.
States may only terminate or reduce coverage for enrollees with overdue cases after Medicaid agencies have completed a full renewal. Renewals will be completed by local Departments of Social Services (DSS) and the Department of Medical Assistance Services (DMAS). Medicaid unwinding will result in up to 300,000 individuals in Virginia losing Medicaid because they are no longer eligible or for administrative reasons.
Federal rules require that states check Medicaid eligibility each year to ensure only eligible individuals are enrolled. This is done through an annual renewal process.
The renewal process has several steps:
- The state attempts to automatically renew the coverage based on available data sources (called an ex parte renewal).
- If coverage can’t be renewed ex parte, the state mails a renewal package and allows 30 days for completion and return.
- Coverage will be terminated if the renewal is not submitted in time. The state must send notice of termination 11 days prior to an enrollee’s termination date.
- If an enrollee does not submit a renewal in time, they will have a 3-month “reconsideration period” to return it. Coverage will be reinstated if they are still eligible.
- Enrollees can appeal reductions and terminations within 30 days.
The first renewals will be initiated in March. That means the first renewal packages for cases that cannot be reviewed ex parte will be sent out in late March or early April. The earliest a termination could occur is April 30, 2023.
It is important to remember that all renewals will NOT happen at one time. They will be spread out as evenly as possible throughout the unwinding period.
Because states have 12 months to start all renewals, Virginia will not review all Medicaid cases at once. Instead, the state will initiate a batch of renewals each month between March 2023 and February 2024. This means that some Medicaid enrollees won’t receive correspondence about their cases for months.
No. Before mailing a renewal package, the state conducts an ex parte renewal where they check electronic data sources to see if coverage can be automatically renewed. If the ex parte renewal is successful, the state will mail a notice telling the enrollee that their coverage has been renewed and they don’t need to take any action. Cases for Medicaid categories that have a resource limit cannot be renewed through the ex parte process — enrollees in these categories will always receive a renewal package.
If the ex parte renewal fails, the state will mail a prepopulated renewal package to enrollees. Individuals should update any incorrect information and complete blank sections. They can attach documents in response to verification requests or to verify changes even if the agency did not specifically ask.
Renewal packages can be completed in three ways. Enrollees can:
- Call CoverVA at 1-855-242-8282 to give information over the phone.
- Submit the information online in their CommonHelp account.
- Mail or drop off the form to their local DSS — this may be the best option if they need to submit documents to demonstrate changes.
If the post office returns someone’s renewal package, the state must try to contact them another way before ending their coverage. If a Medicaid enrollee misses the renewal deadline and their coverage is terminated, they will have a 3-month reconsideration period to submit the renewal package. If they still meet Medicaid criteria, their coverage will resume back to the date of the termination without having to submit a new application. If they miss the 3-month window but believe they are still eligible, they can reapply for Medicaid and request up to 3 months of retroactive coverage.
Enrollees need to make sure that their mailing address is updated with Virginia Medicaid so that they receive renewal packages or approval letters! They can call CoverVA at 1-888-242-8282 to change their address if they have moved. They don’t need to report any other changes until the state starts their renewal.
The state must follow certain protocols before terminating or continuing coverage. They are required to send written notice of an outcome to enrollees. They are required to send written notice of an outcome to enrollees. A termination or reduction of coverage must be sent 11 days prior to the effective date of the negative action, include a reason for the action, and enclose information on how to appeal the decision. Enrollees have a right to appeal any decision within 30 days of the date on the notice informing them about the decision (to appeal after the 30-day period, they must show good cause).
If someone believes that they are still Medicaid eligible, they can appeal the decision, contact the caseworker, or reapply. However, many families — due to income increases or other changes — will no longer qualify for Medicaid. Some individuals may also see their coverage reduced from full Medicaid to a limited coverage program like Plan First (family planning). Anyone who is no longer eligible for full Medicaid should immediately explore other insurance options.
Most individuals whose employers offer health plans will have a 60-day Special Enrollment Period to sign up for employer-sponsored coverage. Those who lack access to employer-sponsored insurance can enroll in a Marketplace plan using a Special Enrollment Period — they don’t have to wait until the Marketplace’s normal Open Enrollment period (November 1 to January 15). The Special Enrollment Period window for Medicaid Unwinding is March 31, 2023 to July 31, 2024. During this window, individuals whose Medicaid coverage is terminated or reduced can sign up for the Marketplace (a) up to 60 days before losing coverage or (b) at any point after losing coverage until July 31, 2024.
Individuals who became eligible for Medicare during the PHE but didn’t enroll because they were enrolled in Medicaid will also have a Special Enrollment Period to sign up for Medicare if they have not done so already.
Virginians can directly contact Medicaid and Marketplace agencies on their own — but if they would like additional support or want help with an application or renewal, they can contact Enroll Virginia. Individuals who need Medicare assistance should reach out to their local VICAP office.
- For Medicaid assistance, you can refer people directly to CoverVA (the state central Medicaid agency) at 1-888-242-8282.
- For Marketplace assistance, you can refer people to the Marketplace’s customer service number at 1-800-318-2596.
- For free Medicare counseling, Virginians can consult this list to find their local VICAP agency.
- For free and unbiased assistance with Marketplace and Medicaid cases, Virginians can find their local navigator or call Enroll Virginia’s statewide helpline at 1-888-392-5132.