Editor's note: This article was sponsored by Coordinated Care.
As pandemic-era protections expire, millions of Americans could lose Medicaid coverage in the coming months.
Those estimates include about 5 million children nationwide, according to a recent survey by the Kaiser Family Foundation (KFF), conducted with Georgetown University’s Center for Children and Families.
While some people might lose coverage because they no longer qualify, others are at risk of losing coverage for simply not responding to administrative requests confirming eligibility. In Washington state, everyone using Apple Health will need to reapply for benefits. People who no longer qualify will need to seek an alternative option, such as finding a plan on the state’s health insurance marketplace.
Maintaining health insurance is important, because it improves access to care and is associated with better outcomes for health and well-being, including lower death rates, according to the American Hospital Association. That’s why it is vital to be proactive about maintaining insurance coverage.
The bottom line, according to health policy experts? Prepare to do the paperwork.
“Keeping up with the paperwork and next steps might seem like a hassle, but if you don’t actively respond, it could result in coverage lapses,” cautions J. Mark Maddox, M.D., chief medical officer at Coordinated Care, one of Apple Health’s managed care plans. “Following up on these updates can impact your health and finances.”
Why is this happening?
As the pandemic intensified in March 2020, the federal government enacted provisions that protected enrollment in Medicaid, the government insurance plan that’s called Apple Health in Washington. That meant renewals and redetermination were put on hold for nearly three years. No one was disenrolled, even if they no longer met the requirements to qualify for the coverage.
During the past three years, Medicaid enrollment nationwide has soared by 30 percent. In Washington state, the program swelled about 25 percent as people stayed on, despite no longer meeting the qualifications. Now that the protections have expired, though, states can begin the process of disenrolling people who no longer qualify. Health experts also fear that eligible people could also lose coverage if they are unable to complete the paperwork involved in the renewal process.
In Washington state, the pandemic’s health insurance protections expired on March 31, which means the first round of people will lose their coverage at the end of the grace period in late May. The disenrollment process will last about a year.
Facing renewal, exploring options
There is some cause for optimism for Apple Health members. Washington is one of the eight states with the most policies and procedures designed to promote continued coverage, even as the pandemic protections disappear, according to a KFF survey conducted in May. Those will prove vital tools in helping the estimated 2 million people who will now face the renewal process.
That includes policies such as a 90-day grace period for eligible Apple Health members who miss the renewal cutoff. If these members complete their documentation during that window and are eligible, they can maintain continuous coverage. Those who are no longer eligible will also have a 60-day window from their “term date,” or the date that coverage expires, to find an alternative coverage plan.
The state’s health insurance marketplace, called Washington Healthplanfinder, offers many low-cost options that can still make health-care coverage affordable for people who earn too much to qualify for Medicaid but don’t have a lot of income to spare. For example, there is a premium tax credit for people who earn 100–400 percent of the federal poverty level. Other options include enrolling in employer-sponsored insurance plans.
Navigating the complexity
To ensure qualified members maintain coverage, it’s important to closely follow these upcoming policy changes, health advocates say.
“Maintaining continuous health insurance coverage is crucial to ensure families can access and afford vital health-care services,” says Maddox. “There’s a peace of mind that comes from knowing that you and your family are protected against the high costs of unexpected medical emergencies.”
As members navigate the weeks ahead, here are a few commonly asked questions:
What factors could influence whether I still qualify for Apple Health?
Income level and family size are two key factors that could impact eligibility.
If nothing has changed with my income or family size, do I have to do anything?
Yes. You should receive communications in the mail a few months before your Apple Health anniversary detailing instructions on how to verify your eligibility.
Can I reenroll early?
If you aren’t within a 45-day window of your anniversary, there’s not a lot you can do other than ensure your mailing address on file is accurate. You can update information and check eligibility at wahealthplanfinder.org or through the WAPlanfinder mobile app.
What if I can’t find the letter or am unsure about my renewal date?
Along with visiting wahealthplanfinder.org, you can also call Apple Health at 1-800-562-3022.
What happens if I no longer qualify for Apple Health but I can’t afford health insurance for my family?
There are multiple low-cost options available at the state’s online health insurance marketplace, where 4 out of 5 consumers can find a plan for less than $10 a month, the state says. The 2023 marketplace includes a dozen insurers that offer a variety of coverage and cost options. Coordinated Care, for example, offers low-cost options such as Ambetter, Maddox notes. You can also check to see if you or your spouse has an insurance option through an employer-sponsored plan.
I don’t have Apple Health but I’m interested in it — how do I see if I qualify?
Households earning less than 138 percent of the federal poverty level may qualify for free coverage through Medicaid/Apple Health.
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