Are you at risk of losing Medicaid coverage? What you should know

Millions of Americans, including hundreds of thousands of Arizonans, could lose their Medicaid coverage over the next year, starting April 1.

Medicaid is a government health insurance program for low-income people. In Arizona, it is known as the Arizona Health Care Cost Containment System.

Here’s what to know about a major upcoming change with AHCCCS and Medicaid programs across the U.S.

What is changing with Medicaid?

AHCCCS leaders as of February had identified more than 25% of current enrollees, or an estimated 674,460 people in Arizona, who are at risk of getting kicked out of the program over the next year because a freeze on disenrollment is ending. Disenrollment notices will be sent beginning April 1.

During the COVID-19 pandemic, state Medicaid programs that accepted increased federal matching dollars were prohibited from dropping anyone who was enrolled as of March 18, 2020. States that accepted the enhanced funding couldn’t remove any new enrollees, either. As a result, enrollment grew and uninsured rates dropped.

The freeze on disenrollment from Medicaid changed as part of a congressional end-of-the-year spending bill. The Consolidated Appropriations Act, which was signed into law Dec. 29, says states that accepted the enhanced federal funding, including Arizona, may resume disenrollments beginning April 1.

The Kaiser Family Foundation estimates that between 5 million and 14 million people could lose Medicaid coverage over the next year as a result of the disenrollment freeze ending. Other estimates say the number of people who lose coverage could be as high as 15 million.

Who is covered by Medicaid in Arizona?

Nationally, enrollment in Medicaid is at nearly 91 million people. In Arizona, one in every three residents, or 2.5 million Arizonans, is enrolled in AHCCCS. The vast majority are ages 64 and younger.

The latest enrollment data shows 53.3% Arizonans covered by AHCCCS are female and 46.7% are male. And 900,461 enrollees, or nearly 40% of all those covered, are children and infants ages 17 and younger. Nearly half of the people enrolled are between the ages of 22 and 64.

A 2022 Kaiser Family Foundation analysis of Arizona’s AHCCCS population says 68% of the program’s non-elderly enrollees are people of color. Nearly half of all births in Arizona are paid for by AHCCCS, the analysis says.

Who is eligible to be covered by Medicaid?

Eligibility in the program varies depending on the category and also varies by state. There are different AHCCCS income limits, for example, depending on whether an enrollee is pregnant, is over the age of 65, who has a disability or who has dependents.

Generally, for a single adult in Arizona, the qualifying household income is $19,392 per year or less, which works out to 138% of the federal poverty level.

What does Medicaid cover in Arizona?

While AHCCCS pays for most types of health care, including preventive doctors’ visits, hospital stays and emergency room care, it does not cover comprehensive dental or vision care for people over age 21. It also does not pay for hearing exams or hearing aids for people over age 21.

AHCCCS pays for crisis and inpatient behavioral health care and uses contractors to provide long term care services such as assisted living, adult day care, nursing homes and home health aides.

How can I be sure to remain enrolled?

Members will only be disenrolled if they no longer meet eligibility requirements or do not respond to requests from AHCCCS for more information through the renewal process. AHCCCS officials say they must make a goodfaith effort to notify people before disenrolling them.

If you are currently enrolled, make sure your information with AHCCCS is up to date, and if you get a notice requesting information from AHCCCS, make sure to respond.

AHCCCS is asking all members to make sure their mailing address, phone number and email address on file are correct in Health-e-Arizona Plus.

Enrollees may log in to www.healthearizonaplus.gov or call 1-855-HEAPLUS (1-855-432-7587) from 7 a.m. to 6 p.m. Monday through Friday. Enrollees may also sign up for text or email alerts from AHCCCS at www.healthearizonaplus.gov.

Some people will be disenrolled because their income increased and they no longer qualify for AHCCCS. In those instances, enrollees should be trying to find other health insurance. Members who are no longer eligible for Medicaid will see a referral to healthcare.gov on their discontinuance notice, AHCCCS officials say.

What happens if I get a disenrollment notice?

AHCCCS has an appeal process that members should use if they believe their discontinuance may be in error.

Appeal information, including the date by which they need to appeal, will be included in the discontinuance notice, AHCCCS officials said.

Also, any enrollee who fails to respond to the agency’s requests for information may submit the requested information within 90 days without having to resubmit a new application.

How long does it take to be approved for Medicaid?

For most programs, the established timeframe for processing applications is within 45 days of receipt.

But the application processing time varies depending on the program and how quickly an applicant responds with any requested information, AHCCCS spokesperson Heidi Capriotti wrote in an email.

“Approximately 80% of applications are processed in less than 30 days, with approximately 20% of applications receiving a decision within one day,” Capriotti wrote. “For most programs, coverage is effective as of the first day of the month of application.”

What is my deadline to avoid disenrollment?

The disenrollment process is scheduled to take place over a 12-month period, with the first notices going out in April. The best advice for enrollees is to make sure they check their U.S. Postal Service mailbox for a letter from AHCCCS about renewal of coverage and to respond to any requests from AHCCCS for more information so the agency can accurately determine eligibility.

While about 25% of Arizonans covered by AHCCCS are at risk of getting a disenrollment notice, that also means that a large majority − 75% − will not need to take any action.

Approximately 75% of eligibility determinations are able to be completed automatically, AHCCCS officials said, which means enrollees don’t need to do anything.

If their eligibility is continued, then they will remain enrolled and will receive a summary letter that says: “If the information on the summary is correct, you do not need to do anything. You do not need to call or contact AHCCCS.”

What happens if I now earn too much money to be on the Medicaid program?

If AHCCCS enrollees are now earning too much money to qualify for the program, they may be able to afford coverage, with federal subsidies to help pay for it, through the Affordable Care Act, or Obamacare, plans.

The marketplace created by the ACA, often called Obamacare, is for workingage people who earn too much to qualify for Medicaid (the Arizona Health Care Cost Containment System) and don’t have other health insurance coverage.

There’s a special enrollment period for ACA coverage for qualified individuals and their families who lose Medicaid or KidsCare (the federal Children’s Health Insurance Plan, known as CHIP) coverage starting March 31 and ending July 31, 2024, federal officials recently announced.

Four out of five Americans who purchase 2023 Obamacare/ACA health insurance can find plans for $10 or less per month when subsidies are included, federal health officials say. Several factors may affect pricing, including age, income, geographic area and the tier of plan that one buys.

Some states have their own insurance exchanges. Arizona uses the federal exchange, which operates via the website healthcare.gov and CuidadoDeSalud.gov or at 800-318-2596.

Where can I get help?

Cover Arizona has no-cost health insurance enrollment assistance, with virtual or in-person options available. Visit www.coveraz.org/connector or call 1-800-377-3536 or 2-1-1 for an appointment.