February 10, 2023
Important Update: Medicare Members to Be Impacted by Medicaid Redetermination
Starting in April, states will have the ability to resume the Medicaid Redetermination process after three years of being paused due to the COVID pandemic. States can begin to initiate the redetermination process as early as February 1, 2023, and disenrollments can be effective as early as April 1 if adequate notice is given to the enrollee. Each state will set the date for when redetermination will start.
Approximately 15 million individuals will be at risk of losing Medicaid coverage. Anyone who is no longer eligible for Medicaid will be disenrolled. Wellcare members set to be disenrolled from their Medicaid plans will need your help to obtain new coverage and maintain continuity of coverage.
Be On the Lookout
Detailed communications will follow soon with state-specific information. Be sure to read these communications thoroughly and familiarize yourself with the processes and effected dates.
- Refer to state-specific resources for dates and deadlines for Medicaid Redetermination.
- Assist members with upcoming redetermination changes.
- Remind current members:
- Expect calls from notified members who are no longer eligible for Medicaid and need alternative coverage options.
- Remember that prospective members will be subject to eligibility determination.
Let’s ensure our members don’t experience a gap in coverage.
- Wellcare D-SNP beneficiaries who no longer qualify for Medicaid will be disenrolled after the deeming period and will need other coverage options. Wellcare implements a six-month deeming period for D-SNP (Tennessee is the exception at three months).
- For individuals no longer eligible, brokers should discuss non-dual Medicare plan options. Those eligible for Medicare, they will have a 60-day window during which they can transition to Medicare without any late enrollment penalties.
- Secondarily, members losing Medicaid eligibility may explore Ambetter Health Marketplace plan options. The window to enroll in a marketplace plan will start 60 days before their Medicaid coverage ends and will continue for 60 days after it ends.
- Current members under Wellcare D-SNP will be supported by our Wellcare partner, Centauri, to help members reapply for Medicaid and the Medicare Savings Program.
Additional information will be provided at the state level as each state confirms their Medicaid Redetermination process initiation date. A follow-up communication will be sent at that time which will provide additional resources to help you in assisting your clients.
As always, thank you for your continued partnership.
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Contact a Pinnacle Representative if you have any questions.
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