Medicaid renewals and redeterminations

Medicaid eligibility is not permanent. It is checked again on a regular cycle called renewal or redetermination. For most people that cycle is once every 12 months. The renewal matters as much as the original application: during the pandemic-era pause on renewals, tens of millions of people kept coverage without a check, and when states resumed normal renewals, millions lost coverage, many of them because paperwork went missing rather than because they no longer qualified. Understanding the renewal rules is therefore practical self-defense.

The 12-month rule and the automatic renewal first

For MAGI-based coverage, federal regulation requires renewal once every 12 months and no more frequently. Before your state asks you for anything, it must first try to renew you automatically, a process called ex parte renewal, using information it already holds: wage data, benefit records, and other reliable sources. If that data confirms you are still eligible, your coverage is renewed without you lifting a finger, and you receive a notice saying so. Only if the automatic check cannot confirm eligibility does the state send you a renewal form, pre-filled with the information it has, and it must give you at least 30 days from the date on the form to return it.

For non-MAGI groups, such as older adults and people with disabilities, eligibility is redetermined at least every 12 months, and the state must also attempt an ex parte renewal where it has sufficient information. The forms and the data sources differ, but the principle is the same: the state checks what it already knows before it asks you.

The 90-day reconsideration window

If your coverage ends because you did not return the renewal form or the information the state asked for, you are not necessarily starting over. For MAGI-based coverage, federal rules require the state to reconsider your eligibility if you return the form and the missing information within 90 days after the termination date, without requiring a brand-new application. If you are found still eligible, coverage can be restored, and in many cases it can be restored back to the termination date. For non-MAGI groups the 90-day reconsideration period is a state option rather than a federal requirement, but many states have adopted it. Even after 90 days, you can always file a new application.

Changes you must report during the year

Renewal is annual, but some changes must be reported when they happen, not at renewal. Moving to a new state, a change in household composition, and a change in income that you expect to last can all affect eligibility, and your state will tell you which changes it requires you to report and within how many days. Children are protected by a separate rule: since January 1, 2024, states must provide 12 months of continuous eligibility for children under 19 in Medicaid and CHIP, so a rise in family income mid-year does not end a child's coverage before the 12 months are up. Adults do not have an equivalent nationwide continuous-eligibility guarantee, which is one more reason to report changes promptly and to answer renewal mail on time.

What to do when the renewal form arrives

Open it the day it arrives. Check the pre-filled information for errors, especially household members and income. Correct what is wrong, sign it, and return it by the method the form allows: online, by phone, by mail, or in person. Keep a copy and a record of when and how you sent it. If the deadline is close and you cannot complete the form, call the agency before the deadline rather than after it: a phone renewal is accepted in many states, and a documented call creates a record that a lost envelope does not.

Sources: 42 C.F.R. section 435.916 (regularly scheduled renewals); Medicaid.gov, renewal guidance and state compliance materials; Medicaid.gov, Continuous Eligibility; Consolidated Appropriations Act, 2023, section 5112.