What does “unwinding” mean?
“Unwinding” is the process by which states will resume Medicaid eligibility renewals for all enrollees and states will be able to terminate Medicaid enrollment for individuals who are no longer eligible..
How are my healthcare benefits affected?
Individuals enrolled in Medicaid since March 2020 are still enrolled today, and will be at least through April 1, 2023 when the continuous enrollment provision ends. When states resume redeterminations and disenrollments, individuals may be at risk of losing Medicaid coverage or experiencing a gap in coverage, even if they remain eligible for coverage. It is very important to complete and return your renewal form when received to prevent any delays in coverage.
What needs renewed?
The Department of Health and Human Resources (DHHR) will send renewal notices and requests for information to enrollees. When enrollees respond, agencies will process the cases, renew coverage for those who remain eligible, and notify those who are no longer eligible that their coverage will end. If enrollees don’t respond, their coverage will end.
When will Medicaid enrollees begin receiving notifications for renewals?
Enrollees will begin receiving renewal letters in February 2023. Medicaid renewals will be staggered over the next 12 months. Enrollees will receive notices sent to their current mailing address, when their renewal is due. Be sure to watch for letters from DHHR and to complete the renewal forms.
What happens when you don’t renew in time?
Failure to complete renewal can result in loss of your healthcare coverage. Under federal law, individuals have 90 days from the date the case was closed to provide the Medicaid agency with all required information, Medicaid benefits can be reinstated without going through the application process if the individual continues to meet the eligibility criteria. If the required documentation is not submitted within the 90 day period to complete the redetermination process, the individual will be required to reapply for Medicaid benefits and a gap in healthcare benefits is likely to occur.
Where can I find more information about the Marketplace?
If you were found ineligible for Medicaid and/or WVCHIP, your application has been sent to the Federally Facilitated Marketplace to be evaluated for healthcare coverage. The Marketplace will be sending you a notice with information about how to apply. If you would like additional information about the Marketplace process or next steps, West Virginia also has a program called WV Navigator that can provide free enrollment assistance in Marketplace health insurance plans. You may contact WV Navigator at (304) 356-5834 or visit the WV Navigator Website.
Can I submit my Medicaid or WVCHIP renewal form, or a new application, any time during the unwinding period, before my scheduled redetermination month?
No. You must wait until you receive your renewal form from the DHHR. Renewal forms should be submitted the month before, or the month of, the scheduled redetermination. If needed, members can report changes in their household circumstances by contacting the Customer Service Reporting Center at 1-877-716-1212 or their local DHHR office. Members may request closure of their Medicaid or WVCHIP coverage at any time.
West Virginia DHHR has deliberately planned renewals in a manner that does not exceed the Center for Medicare and Medicaid Services' (CMS) prohibition on scheduling more than 1/9 of our total caseload per month. Agencies and application assistors who encourage members to submit an early renewal or new application could result in West Virginia exceeding this limit and jeopardize federal funding for the Medicaid program. This also impedes the local offices’ ability to manage their workload, adds extra unnecessary work on the case workers which may cause backlogs, and confusion for members and staff.