Medicaid Redeterminations Revisited – Part 1

There are many misconceptions about Medicaid and the application process.  One of them is that after Medicaid is approved, ”we are home free”, so to speak, meaning no more worries about the eligibility requirements.  Unfortunately, not true.

As I often tell new clients and their families, we first must focus on meeting all of Medicaid’s financial and medical eligibility requirements before applying for benefits.  Once Medicaid is approved, “I will then tell you how not to lose Medicaid benefits”.  That’s because Medicaid conducts an annual redetermination process.

Over the years, this process has changed.  Back when I filed my first Medicaid applications in the 1990’s, redeterminations were sporadic.  They were not conducted annually and some counties (Medicaid applications are filed with the board of social services of the county where the applicant resides) never seemed to conduct them at all.

That changed maybe 6 or 7 years ago.  Now all the counties routinely send annual notices and redetermination applications. While the redetermination process is much easier than the application process, problems do exist, some of which I have written about in the past.  For example, despite my office having filed the original application, I tell families that when it comes to getting the redetermination notice, it may be sent to us, the Medicaid recipient or a family member.  There does not appear to be any rhyme or reason as to whom the notice will be mailed to.

Additionally, when the notice is mailed to the Medicaid recipient, who is more likely than not to be in a facility and no longer able to read or understand his or her mail, it seems to frequently not make its way to my office or to the recipient’s family.  As a result, we have had a number of families calling us in a panic that Medicaid benefits have or are about to be terminated.

More recently, within the last few months, the State has changed the redetermination application itself so that it now looks more like the original application.  I’ll explain what I mean next week.