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Medicaid Eligibility and Redeterminations

Date: 01/13/23

A Public Health Emergency (PHE) in response to the COVID-19 pandemic was declared in March 2020. The Families First Coronavirus Response Act (FFCRA) prohibited states from disenrolling Medicaid recipients in order to provide continuous coverage during the emergency. Under the Consolidated Appropriations Act 2023, expiration of the continuous enrollment condition will no longer be linked to the end of the PHE. The continuous enrollment condition will end on March 31, 2023.

  • “Unwinding” continuous coverage policies and resuming “regular operations” will require providers to help educate patients so they do not lose coverage; and
  • States will have up to 12 months to return to normal eligibility and enrollment operations.

Nearly all 80 million people enrolled in Medicaid will have their eligibility redetermined, triggering a high risk of coverage losses:

  • This risk can be mitigated through careful planning by Centers for Medicare & Medicaid Services (CMS), states, health plans, providers, consumers and advocates;
  • Patients can lose eligibility due to changes in age, household income, and other state-specific criteria; and
  • Loss of coverage could make it harder for patients to get medical care and result in expensive medical bills.

Superior HealthPlan Medicaid (STAR, STAR Kids, STAR+PLUS) STAR+PLUS Medicare Medicaid Plan (MMP) members who have moved, those with limited English proficiency (LEP), and people with disabilities, may be at greater risk for losing Medicaid coverage.

Help your patients avoid gaps in coverage and let them know:

  • They are required to verify eligibility every year, or risk losing their Medicaid coverage, by visiting YourTexasBenefits.com.
    • They should receive a notice by mail, or email if they signed up to go paperless from the Texas Health and Human Services Commission. The letter will be in a yellow envelope with the words "ACTION REQIURED" in red.
  • They must follow through on eligibility renewal instructions or risk having their coverage canceled.
  • If they are no longer eligible for Medicaid coverage, they can explore other options, such as Superior’s Marketplace (Ambetter) or Medicare (Wellcare By Allwell) health plans.

Additional information can be found online: