March 2020 marked the beginning of a crucial period for Medicaid and PeachCare for Kids® members—the U.S Congress passed the Families First Coronavirus Response Act (FFCRA) in response to the economic impact that the COVID-19 public health emergency (PHE) left on families.
Prior to the pandemic, states were required to annually re-verify that all current Medicaid members were still eligible to receive coverage. This process of demonstrating continued eligibility for access to Medicaid is called redetermination. What FFCRA essentially did was boost funding under the condition that states guaranteed continuous coverage for almost all Medicaid members on/after March 18, 2020, regardless of whether they still met those eligibility requirements or not.
What Medicaid and PeachCare for Kids® members need to know now is that on March 31, 2023, the pause on Medicaid redeterminations ended. Consequently, states can resume the process of checking who still qualifies for Medicaid coverage on April 1st. Those who no longer meet Medicaid eligibility requirements will lose access to Medicaid.
The end of this “continuous coverage” requirement will now present one of the largest health coverage transitions since the first open enrollment period of the Affordable Care Act for a lot of families. States will have a 14-month window from April 1st to start conducting redetermination. This will involve states collecting and verifying information such as income and contact details of Medicaid members, along with other requested information/documents related to determining everyone’s eligibility.
In Georgia, it can be expected that about 2.7 million individuals will be reevaluated for Medicaid eligibility. If a Medicaid member is still eligible to receive Medicaid coverage, their coverage will simply be renewed. However, individuals who are no longer eligible for Medicaid will lose their Medicaid coverage but may qualify for other health coverage options.
Know Your Medicaid Status:
At this time, Georgia families will begin receiving Medicaid alerts and notifications in their email or mailbox. If you or your family are enrolled or unsure of whether you are enrolled in Medicaid/PeachCare for Kids® coverage, now is the time to take action to learn what your Medicaid status is.
To begin, first visit staycovered.ga.gov and confirm or update your contact information to stay in control of your healthcare. After doing so, you’ll stay updated by receiving alerts, updates, and resources related to your Medicaid status.
Need Help Determining your Status?
If you would like help with this process, you can schedule an in-person visit for assistance at your local Division of Family & Children Services office. To figure out what the address and business hours of your local office is, visit: dfcs.georgia.gov/locations.
If you also need help reading this information or communicating with them, you can call 1-877-423-4746. The services offered at this number include free interpreting services. Additionally, if you are deaf, hard of hearing, deaf-blind or have difficulty speaking, you can call the number above by dialing 711 (Georgia Relay).
Have you Lost Medicaid or PeachCare for Kids coverage after the redetermination process? Contact Georgia Health Insurance, inc!
If you or your children lose Medicaid or PeachCare for Kids® coverage, no need to worry! Our agent Daniel or Josiah would love to help you find out what your other health insurance options are so that you or your children don’t go without coverage! For assistance, feel free to give us a call at 770-452-9335 or Click HERE to schedule a free phone or video call with Daniel to go over all your health insurance options in Georgia and help you enroll!
Think you might be eligible for Medicaid?
You may be able to sign up for Medicare without paying a late enrollment penalty.
- If you now qualify for Medicare, but didn’t sign up for it when you first became eligible, you have a limited time (called a “Special Enrollment Period”) to sign up without paying the usual penalty.
- Your Special Enrollment Period starts the day your state notifies you that your Medicaid coverage is ending, and continues for 6 months after your Medicaid coverage ends.
- To sign up for Medicare during this Special Enrollment Period, fill out a CMS-10797 form and mail or fax it to your local Social Security office. You can also call Social Security at 1-800-772-1213. TTY users can call 1-800-325-0778.
Common Questions Regarding Medicaid Redetermination:
When is the deadline to update my contact information?
It is important that you update your contact information at gateway.ga.gov before April 1, 2023, so you can receive the information you need about your Medicaid status. Your individual redetermination process may begin anytime during the 14-month redetermination period, from April 1, 2023, to May 31, 2024. So, do not be alarmed if you do not receive a notification immediately during the first few months – just make sure you have the correct contact information in Gateway and wait patiently for your notification.
How do I apply to keep my Medicaid coverage?
The most important step right now is to update your contact information at gateway.ga.gov as soon as possible. You will then receive further instructions via email or U.S. mail when your case has been opened for redetermination.
My children have health insurance through PeachCare for Kids®. Does this redetermination process affect them?
Yes. Anyone covered by Medicaid, including PeachCare for Kids®, must be redetermined for eligibility once redetermination begins on April 1, 2023.
Gateway Website – https://www.gateway.ga.gov/access/
What if I cannot log into my online account?
If you are having trouble with your online account, we recommend calling 1- 877-GA-DHS-GO (1-877-423-4746).
I am locked out of Georgia Gateway. Who do I contact?
If you entered the wrong username or password multiple times, the system may temporarily lock you out. From the login page at gateway.ga.gov, select “Forgot User ID” or “Forgot Password” to receive a one-time PIN delivered to your mobile phone or email to recover your username or password. If you need additional support, you can schedule an in-person appointment for support at your local Division of Family and Children Services office. To find the location and business hours for your local office, visit: dfcs.georgia.gov/locations. For help reading this information or communicating with us, call 1-877-GA-DHS-GO (1-877-423-4746). If you are deaf, hard of hearing, deaf-blind, or have difficulty speaking, you can call us at the number above by dialing 711 (Georgia Relay).
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You can read our 2023 Guide to Health Insurance Here: https://ga-health-insurance.com/2023-georgia-ifp-guide/
Question and Answer:
Q1: Does the unwinding affect people who are dual enrolled in Medicaid and Medicare?
A1: It could, if the consumer no longer qualifies for Medicaid, then they could lose Medicaid. But if they have Medicare, they won’t qualify for help paying for Marketplace coverage.
Q2: What are we supposed to do when assisting a member that was denied for Medicaid or lost Medicaid when it comes to inputting their income? I have had several members that try to enroll based on their income and the site states that their income is too low to get the subsidy and then show full price plans. This does not make sense!
A2: In some states, particularly in states that have not expanded Medicaid, there will be consumers who lose Medicaid but whose income is not high enough (at least 100% FPL) to qualify for APTC/CSRs.
Q3: Will they need to upload the disenrollment letter?
A3: They will not need to upload their disenrollment letter when they apply. If any additional documentation is needed, they will be informed in their Electronic Determination Notice (EDN).
Q4: Can an individual who lost coverage (Medicaid) mid-month apply prior to the ending of Medicaid so there is no gap in coverage? They would have 2 weeks of double coverage. Ex. Medicaid terms 5-15, enroll & selects a plan on 4/30 for a 5/1 effective.
A4: Hi Carla, for consumers applying for a future loss of Medicaid using the Unwinding SEP, their coverage effective date is the first day of the month following their last day of Medicaid coverage. So, they would not be able to apply on 4/30 for a 5/1 effective day if they are losing coverage on 5/15.
Q5: Let’s say a family of two young adult, husband, and wife. Wife working on a regular 9-5 job, and the husband is working as freelance job. The wife’s job provides her health insurance, and the husband can get the same plan as the employee’s family member but with double or triple of the monthly premium that they cannot afford, and also their total annual income is barely over the state Medicaid income line. So, now the question is, can they both enroll to the Marketplace plans or not?
A5: They should definitely fill out a Marketplace application and check. If the family plan premium is more than 9.12% of household income, then the husband will likely qualify for a tax credit to help pay for the Marketplace plan. The family can choose to keep the wife on the employer coverage and enroll just the husband in the Marketplace coverage if the self-only employer plan is affordable.
Q6: What happens if they estimated their income within the minimum threshold and qualify to enroll in the marketplace but at the end of the year, they didn’t make enough will they end up paying it back?
A6: If their tax household annual income as reported on their tax return is below the threshold to receive the premium tax credit, IRS does have a safe harbor that protects consumers from having to pay back APTC on that basis. Noting that the Marketplace will still verify the income attested to on the application.
Q7: Can she repeat that part about not having to pay back?
A7: If a consumer thought their income would be above 100% FPL when they enroll at the Marketplace, but during the year they experience an income decrease and their actual annual income at tax time is below 100% FPL, the IRS instructions for form 8962 (see line 5 instructions) say that the consumer can still receive the PTC on their tax return, as long as the consumer did not with ” intentional or reckless disregard for the facts, provided incorrect information to a Marketplace for the year of coverage”
Q8: Question about the SEP for below 150% FPL. Is this ending soon or continuous? until When? Is this apart of the Medicaid Unwinding?
A8: The 150% FPL SEP is separate from Medicaid Unwinding, this SEP is tied to the Inflation Reduction Act and will last under December 31, 2025, unless Congress passes additional legislation to extend it.