QUESTION

I went to the doctor and they told me I no longer am enrolled in Medicaid. I never got a notice from the Medicaid agency. What should I do?

Transitions from Medicaid to Private Insurance | Transitions from Medicaid to Private Insurance |
ANSWER

If you believe your Medicaid benefits were wrongfully terminated, you should contact your state’s Medicaid agency. If you moved while you were enrolled in Medicaid but did not notify the agency of your change of address, you may not have received the notice about the need to redetermine your eligibility for Medicaid. Under federal law, state Medicaid agencies may not disenroll you from Medicaid based on returned mail, without first making a good faith effort to contact you using other means, such as telephone, email, or text. If you believe your state’s Medicaid agency did not make a good faith effort to contact you using mail or other means, you should contact your Medicaid agency as soon as possible. You may be able to appeal the termination of your enrollment by requesting a hearing. You can request a hearing by mail, in person, by telephone, or online. (42 C.F.R. Part 431, Subpart E)

If you were terminated from Medicaid for administrative reasons, such as a failure to submit required documentation, but you believe you are still eligible based on your income, you should submit the missing information within 90 days of your termination, and if you are in fact still eligible your Medicaid agency is required to reinstate your coverage once your renewal is processed. If it has been more than 90 days since your termination, you may reapply for Medicaid benefits at any time. In most states, in either situation, your coverage can be made retroactive up to three months if you received services that would be covered by Medicaid during that time, and met eligibility requirements at the time you received such services. (42 U.S.C. § 1396a(a)(34); 45 C.F.R. §§ 435.915, 435.916)

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