What Happens If You Are No Longer Eligible for Medicaid?
- Learn where to turn when you are no longer eligible for Medicaid. Depending on your state and situation, there may be other health care options available at an affordable price.
If you are no longer eligible for Medicaid, there are other options that can help you maintain health insurance for you and your family. Before you can apply for them, you need to determine why you became ineligible for Medicaid benefits and what alternative health care options might pertain to your specific situation.
Understanding Why You Are No Longer Eligible for Medicaid
Individuals get dropped from Medicaid or denied Medicaid for a variety of reasons. One major reason you might discover that you're ineligible for government-covered health care is that your income has risen since you last applied. Medicaid is designed for people who meet certain income guidelines, which are adjusted each year based on poverty levels. If your income rises above the level your state uses to define Medicaid eligibility, you lose access to the program.
Income levels for Medicaid eligibility also take into account family size. If you have a child who has aged out of being a dependent, a divorce or death in the family has reduced the amount of people in your home, or your family size has changed in other ways, this may affect your eligibility even if your income is the same.
Another common reason people lose Medicaid eligibility is when they get new jobs with employer-provided healthcare. If your workplace offers health insurance as a benefit, you can't continue to use Medicaid.
Some people in specific circumstances are eligible for Medicaid, so if these circumstances change then your eligibility could end. Pregnant women who meet specific income guidelines and people who receive Supplemental Security Income are examples of this kind of federally-mandated eligibility. Individual states also may opt to cover certain groups of people, such as individuals receiving certain community-based services. If your circumstances change and you no longer fit into one of these categories, you may no longer be eligible for Medicaid.
Some states have opted not to expand Medicaid eligibility under the guidelines allowed by the Affordable Care Act (ACA), so if you move from a state with expanded Medicaid to a state without it, you may lose eligibility.
Health Care Options When You Get Dropped from Medicaid
Special Enrollment Period
If you have a job and your employer offers health insurance, you can apply for this insurance to ensure you have health care coverage after your Medicaid coverage ends. People without employer-based health care can find a plan on the Healthcare.gov website. Because losing Medicaid coverage is considered a qualifying life event, you should qualify for a special enrollment period and be able to get health care even if you have to apply outside the regular yearly enrollment period. To qualify for a special enrollment period, you need a denial letter from Medicaid showing that you are no longer eligible.
Many people who no longer qualify for Medicaid still qualify for government subsidies on the Healthcare.gov marketplace. These subsidies are income-based and may cover all or part of your insurance costs. You can also get short-term health insurance to fill in any coverage gap between when you lose Medicaid and an employer-based or government-subsidized plan starts.
If you're an older adult who is no longer eligible for Medicaid, you might be eligible for Medicare. Medicare is designed for people age 65 and older, and you may be automatically enrolled once you reach that age and start receiving social security benefits. You can often switch directly to a Medicare Advantage Plan or Medicare Prescription Drug Plan from Medicaid without any coverage gaps.