What’s “Unwinding” or “Medicaid Renewal” All About and Why Should I Pay Attention?

By Andrew Capehart, Director, APS TARC

What Is “Unwinding”?

As a former APS worker, I know how important Medicaid can be for eligible adults who are older and/or have disabilities. Waiver services and payment for health care could often make or break a case. Medicaid was often the key to keeping someone independent and in their own home.

During the COVID-19 pandemic certain rules about Medicaid eligibility were relaxed so people with Medicaid would have access to health care during the public health emergency. One big change was that redeterminations of eligibility for Medicaid were suspended to prevent people from losing their Medicaid coverage. According to Medicaid.gov, more than 94 million people were enrolled in Medicaid as of April 2023 and, as of 2020, 8% of those enrolled are over the age of 65 and 10% were persons with a disability.

When the pandemic public health emergency ended in May 2023 this Medicaid leniency ended and states have returned to reassessing eligibility for Medicaid for every Medicaid beneficiary. All states are now engaged in redetermining Medicaid eligibility for every single Medicaid beneficiary, from kids to older individuals, people qualifying on the basis of disability, people receiving Medicaid home and community-based services, and residents of residential long-term congregate settings, likely affecting many APS clients.

In every instance, Medicaid agencies are required to evaluate and award eligibility for any kind of Medicaid for which the individual qualifies, not just the kind of Medicaid the beneficiary had been receiving, and can only discontinue Medicaid if the beneficiary isn’t eligible for any kind of Medicaid that the state offers. Yet many people with Medicaid are unfamiliar with the redetermination process since it was suspended for three years.

Why Should I Pay Attention to It?

We are seeing alarming trends of many people losing their Medicaid. Many of these people are being cut off for what are called “administrative reasons,” meaning their eligibility was not reassessed but instead their paperwork wasn’t processed, papers got lost, the Medicaid office couldn’t connect with them, or for other similar reasons. According to the Kaiser Family Foundation, more than 5.2 million people have been disenrolled from Medicaid as of August 22, 2023. Many of these disenrolled people may be eligible but didn’t start or complete the process of redetermining eligibility. State by state timelines for unwinding can be found on medicaid.gov.

For the people APS serves, losing Medicaid can be disastrous. Not having health access such as for medications that sustain life, to doctors and other clinicians, and to the Medicaid waiver home care services that enable them to live well in their own homes and communities can sometimes be the deciding factor in a person’s ability to remain independent and avoid institutionalization or to transition out of an institution like a nursing home and return to their home. Being alert to indications an APS client may have lost or be in jeopardy of losing Medicaid can be instrumental in supporting to quality of life and recovery from abuse, neglect, and exploitation.

How Can I Help?

Asking clients about the status of their Medicaid could be vital to ensuring their autonomy. Here are a few suggestions for interacting with your clients about Medicaid and the need for all people with Medicare to renew their Medicaid eligibility. Here are a couple of points APS folks could encourage their clients to do:

• UPDATE contact information with the state Medicaid agency immediately.
• RESPOND quickly and completely to Medicaid renewal forms when they come in the mail to avoid losing coverage.

APS workers might learn that a client has already lost Medicaid or has a cut off notice. How would an APS worker find this out? A client may show a worker the discontinuance notice or might say, “I can’t see my doctor anymore” or “I am out of my meds and can’t afford the refill” or “my home aide isn’t coming back and I won’t be able to get ready for my day, get cleaned up, get food ready to eat,” or similar statements.

APS can help — it isn’t “game over.” An APS worker can:

• CONNECT WITH RESOURCES THAT CAN HELP: If a client loses Medicaid coverage, they have legal rights and APS can help connect them to resources to assert those rights and seek to get Medicaid back. We’ll talk about how to get legal help in a moment.
• CHECK OTHER OPTIONS: For clients who are no longer eligible for Medicaid, they may be eligible for other health benefits. First, remember the Medicaid agency should assess their eligibility for all kinds of Medicaid offered in the state to be sure nobody who is eligible gets cut off. Second, most APS clients, whether older or younger with a disability, likely have or are eligible for Medicare. To learn more about Medicare, you can contact the State Health Insurance Assistance Program (SHIP) in your state. People with Medicare are generally not eligible for coverage or the subsidies that make coverage affordable through the Health Care Marketplace, but for those APAS clients who are not eligible for Medicare, you can help them search for coverage and the subsidies that make Marketplace coverage affordable at Healthcare.gov.

Consider reaching out to your state Medicaid agency to learn how to partner together to help APS clients with
Medicaid to recertify their eligibility. Your local legal aid program can help you advocate on behalf of individual
clients to re-establish Medicaid. Legal aid frequently helps clients with public benefits issues and is an
important partner to work with. If you are not yet familiar with your local legal aid programs that work with
older adults, you can make the connection through the Eldercare Locator and/or your local area agency on
aging.

For the adults with disabilities you’re working with, consider contacting your state protection and advocacy program. The national network of protection and advocacy programs provides free legal representation for clients with certain disabilities services that are related to their disabilities. The Legal Services Corporation website can also direct you to your general local legal services grantee.

Working Together

If your APS program doesn’t have a relationship with one or more of these partners, as part of a multidisciplinary team or not, this would be a terrific time to develop and grow a relationship, so consider reaching out and asking to meet. In addition to assisting with Medicaid coverage, they are integral to protecting the self-determination, health, well-being, and safety of those you serve.

We all know it takes that proverbial village. Neither APS alone, nor any single organization for that matter, can cover all the needed services to maintain independence. As partners, all of us can work together to ensure our clients live how and where they choose, while doing so safely.

The TARC is here to help with understanding unwinding and is always happy to make connections for effective partnerships. Reach out to us anytime at apstarc-ta@acl.hhs.gov.