Montana Medicaid Unwinding Information

News

The Medicaid unwinding will start in April 2023

What is the Medicaid unwinding?
During the COVID-19 public health emergency, Montana Medicaid didn’t process re-determinations to check eligibility for Medicaid. There are now more than 300,000 Montanans covered by Montana Medicaid and Healthy Montana Kids. In December 2022, Congress passed a bill that set a date, April 1st, when states can start the process of checking eligibility for Medicaid enrollees. This process is often referred to as the “Medicaid unwinding.”

Will everyone be renewed at once?
No. Montana will take 10 month to complete renewals for all enrollees. Each month (starting in April) a different group will start the renewal process. The final group will start the process in January of 2024.

What is the Department sending out? I just heard that my patients/clients got a notice? 
The Office of Public Assistance recently (mid-March) sent out a notice to all enrollees about upcoming changes. You can see a copy of that notice here. The notice doesn’t end anyone’s Medicaid, just provides information about what is happening with renewals and program changes in the coming months.

The Montana Department of Public Health and Human Services has a new page dedicated to unwinding information. The page has sample notices, frequently asked questions, and more.

What is changing?

  1. DPHHS will begin redetermining Medicaid and Healthy Montana Kids members’ coverage in April 2023. This is because the continuous enrollment requirement for Medicaid/HMK members has ended. We will check if you are still eligible for Medicaid/HMK sometime in 2023.
    • If we need more information to determine your Medicaid/HMK eligibility, we will send you a re-determination packet. You must complete the packet if you receive one by mail or email, or your coverage will end.
    • Once we have finished processing your re-determination, DPHHS will send you a notice that will tell you whether your Medicaid/HMK will continue or end.
  2. For most adults receiving Medicaid, DPHHS will now have to check if you still qualify for Medicaid each time we know of a change in your case. This includes changes in income or household size. We must check if you still qualify each time you report a change and each time our electronic databases show a change. We must end your coverage if you no longer qualify as a result of the change. For more information, see Continuous Eligibility Policy Change Notice for Members.

What do I need to do?

  • Update your contact information – Make sure DPHHS has your current contact information so that you receive important notices. You can expect to hear from us by mail, email, and text message. Update your contact information here.
  • Check your mail – DPHHS Office of Public Assistance will mail you a letter about your Medicaid or HMK coverage. This letter will also tell you if you need to complete a re-determination packet to see if you still qualify for Medicaid or HMK.
  • Complete your re-determination packet (if you get one) – Call us at 1-888-706-1535, go to apply.mt.gov, or return the renewal packet by mail. You will have 30 days to complete this step. If you receive a re-determination packet, you must return it by the deadline, or your Medicaid/HMK will end.
  • Report any changes in your household that might affect your eligibility for Medicaid. These include:
    • Changes in your address
    • If someone gets married or divorced
    • If someone moves in or out, becomes pregnant, adopts a child, or any other changes in the people who live in your home
    • If someone’s income changes
    • Report these changes to DPHHS within 10 days of knowing them by calling us at 1-888-706-1535 or by going to apply.mt.gov.
  • Respond to any requests for information you receive from DPHHS Office of Public Assistance. If we learn of any changes in your case through our electronic databases, we may contact you for more information to see if you are still eligible. If you are contacted by DPHHS OPA, you must respond by the due date, or your coverage will end.
  • Open mail from the Office of Public Assistance right away. If we find you are no longer eligible for Medicaid, you will need to take action to sign up for other insurance. If you don’t act right away, you will have a gap in healthcare insurance.

What happens if I’m not eligible for Medicaid anymore?

  • You may be eligible for other low-cost, quality health insurance through HealthCare.gov (the Health Insurance Marketplace). If DPHHS finds that you are not eligible for Medicaid, we will send your information to HealthCare.gov.
  • Contact Cover Montana for help signing up for insurance through HealthCare.gov. They will connect you to free, confidential, and local help. Visit https://covermt.org/ or call 1-844-682-6837.
  • Take action right away! Contact Cover Montana or the HealthCare.gov as soon as you hear your Medicaid will end so that you don’t have a gap in coverage.

For further assistance or questions call SHIP Counselor’s at Western Montana Area VI Agency on Aging 406-883-7284