Understanding redetermination: An important Medicaid process

This article was written for our sponsor, WellCare of NC.

Redetermination for Medicaid is an annual process that reviews a beneficiary's eligibility for the program. When the public health emergency was declared in 2020, it allowed Medicaid members to keep their membership during the pandemic, even if their eligibility changed. While it is unclear when this may be lifted, beneficiaries should start considering if their situation has changed since. "Once the public health emergency is classified as over, beneficiaries can ensure their enrollment in Medicaid is not disrupted by making sure their information is up to date with the department of social services. Making sure things like your address are correct and things like changes to your phone number and contact information have been updated," said Patrick Garrett, Director of Vendor Management with WellCare of NC.

The state of North Carolina wants to make sure all beneficiaries keep this information up to date so they can receive materials on the redetermination process, which typically takes 90 days in North Carolina. If a beneficiary's eligibility changes after the process, Medicaid will not terminate or reduce benefits until steps are taken to ensure continued healthcare. By contacting the NC Navigator Consortium or by selecting a plan through the healthcare marketplace, individuals can still get benefits if they are ineligible for Medicaid after redetermination.

The importance of redetermination

Redetermination allows the state to review a beneficiary's eligibility for the program. If a beneficiary's circumstances have changed, their benefits may be reduced or terminated. Redetermination also helps to ensure that beneficiaries are receiving the correct level of benefits. If a beneficiary's income has increased, they may no longer be eligible for certain benefits, such as transportation assistance. Alternatively, if a beneficiary's income has decreased or they have added a new baby to the family, they may be eligible for new benefits.

What is required for redetermination?

To complete the redetermination process, beneficiaries will need to provide updated information about their income, assets, and family size. This information can be provided through the online portal or by contacting the Medicaid office. The state will also need to verify this information through documentation.

What if my circumstances changed?

If a beneficiary's circumstances have changed since their last redetermination, they may be required to provide additional information. For example, if a beneficiary has moved, they will need to provide their new address and contact information. If a beneficiary has had a change in income, they will need to provide documentation, such as pay stubs or tax returns.

WellCare of NC reminds members to ensure their information is consistently updated including all income and household size changes. "We also want beneficiaries to notify local DSS of any other coverage changes like a divorce, the birth of a baby, a new job, or another life event that may impact coverage," said Garrett. This information helps to streamline the process and helps Wellcare of NC members keep their Medicaid benefits and avoid any lapse in coverage.

What's next?

The state is currently in the process of finalizing the redetermination process for 2023 although no exact time is set. Beneficiaries should expect to receive notification of their redetermination date in the coming year most likely. While this is not certain, members should still be prepared with updated documentation. You can also follow Wellcare of NC on social media or visit their website for updates on redetermination. To ensure their family and their own needs are met, Medicaid members should explore every option for their care.

When redetermination comes around, beneficiaries can be assured that Wellcare of NC will be there to help them through the process. "We want to make sure our members have the resources they need to keep their Medicaid benefits," said Garrett. "Our goal is to help our members stay healthy and independent."

It's important for beneficiaries to understand the redetermination process and how it may affect their Medicaid coverage. By keeping up to date with their information and notifying the appropriate people of any changes, they can ensure that they continue to receive the benefits they need. When in doubt, beneficiaries can always contact their local Medicaid office or the NC Navigator Consortium for help.

This article was written for our sponsor, WellCare of NC.