What Does COVID Unwind Mean to My Medicaid Coverage?

If you’re now covered by Medicaid, will you be covered in the future? Why might your Medicaid coverage be changing? It all has to do with the “unwinding” of COVID.

States are “unwinding” COVID, meaning that many regulations that were changed or waived during the pandemic are going back to normal.

For Medicaid recipients, this means that your qualifications will be reviewed annually, as in the past, and if your income has increased or your situation has changed, you may no longer qualify. Some states are moving forward based on their previous annual renewal schedule. South Dakota has started to redetermine eligibility, and the process will take nine to 12 months.

How Medicaid Worked During COVID-19

When COVID was declared a public health emergency, a lot of federal measures were put in place to help people navigate through this trying time.

The Families First Coronavirus Response Act of 2020 provided states with a 6.2% increase in Medicaid federal matching dollars. States received increased federal funds if they met certain requirements. This included not disenrolling individuals who no longer qualified. People who had Medicaid were able to keep Medicaid, even if their eligibility changed.

Redetermining Medicaid Eligibility

Now that the public health emergency has been declared to be over, states including South Dakota are redetermining who qualifies for Medicaid and the Children’s Health Insurance Program (CHIP).

In South Dakota, the Department of Social Services began notifying Medicaid recipients of the requirement to renew their qualifications for Medicaid. If you received a renewal form, you should fill it out and return it as quickly as possible. You might not receive renewal information right away.

Other Health Insurance Options

Individuals that no longer meet current Medicaid eligibility will be referred for other coverage, such as the federal Health Insurance Marketplace at healthcare.gov.

• Healthcare.gov is a source for affordable health insurance and you might qualify for financial assistance through tax credits. In fact, four out of five enrollees can find plans that cost less than $10 a month.
• You will have until July 2024 to apply for Marketplace coverage if you lose Medicaid coverage at any point until then and once you submit or update your application, you have 60 days to select a plan.
• Avera Health Plans is an option for people shopping for insurance on healthcare.gov.
• You might have access to health insurance through your or your spouse’s employer.
• If an employer plan is not affordable for you, you can get health insurance at healthcare.gov and might qualify for financial assistance through tax credits.

After South Dakota voters approved Medicaid Expansion in the fall of 2022, Medicaid Expansion for South Dakotans will begin July 1, 2023. If you’ve been terminated from Medicaid, you might qualify with the new expanded eligibility, covering adults with income up to 138% of the federal poverty level.

To talk to a licensed agent about Avera Health Plans options available through the Marketplace, call 855-692-8372.

Or call the Marketplace Call Center at 800-318-2596. TYY users can call 855-889-4325. Visit localhelp.healthcare.gov to find someone in your area.

If you have questions about Medicaid eligibility or your health insurance coverage options, you can find helpful resources at Avera.org/Medicaid.