Paul Sanchez
Thousands of Illinois residents have been terminated from their Medicaid insurance plans, with nearly 47,000 residents being dropped as of August 1, 2023. There are several reasons why an individual's Illinois Medicaid insurance may be terminated, including failure to complete and return the required forms by the end of the 90-day reinstatement period, ineligibility, or failure to submit eligibility information on time. In some cases, individuals may be terminated due to procedural reasons or the end of continuous coverage. It is important for individuals to stay up to date with their Medicaid renewals and to seek alternative coverage options if they are no longer eligible for Medicaid to avoid a lapse in health insurance coverage.
| Characteristics | Values |
|---|---|
| Reason for termination | Failure to submit eligibility information on time |
| Time period for submission | 90-day reinstatement period |
| Action after termination | Enroll in an alternate health plan |
| Time to enroll in a new plan | 30-60 days |
| Special Enrollment Period (SEP) | Available for eligible consumers between March 31, 2023, and July 31, 2024 |
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What You'll Learn
Failure to submit eligibility information on time
If you have failed to submit eligibility information on time, you may lose your Medicaid coverage. It is important to keep your contact information up to date, as the Illinois Department of Healthcare and Family Services (HFS) will send you letters with important information, such as requests for more information or your Medicaid determination. You should send in any requested documents as soon as possible. If you do not, your coverage may be terminated.
If you are denied Medicaid, you will receive a letter in the mail informing you of the reason for the denial. You will then have 60 days from the date of the letter to send in the missing information and have your application reopened and processed. If you are eligible, your healthcare coverage will begin in the month that you applied, or before that if you applied for prior coverage. However, if you miss this 60-day window, you will have to reapply.
If you have lost your Medicaid coverage, you may be eligible for a Healthcare.gov Special Enrollment Period (SEP). Qualified individuals and their families who lose Medicaid coverage due to the end of the continuous enrollment condition may access the SEP by submitting or updating an application through HealthCare.gov. If you are determined eligible, you will have 60 days from the date you submit a new or updated application to make a plan selection.
If you did not return the redetermination (renewal) form or did not renew online, you can call Illinois Medicaid at 800-843-6154 and ask for more time to return the form or for a new form. If you missed the deadline to submit the form, you may have to reapply for coverage.
To avoid losing your Medicaid coverage, it is important to keep your address and contact information up to date. You can update your address online at medicaid.illinois.gov or by calling 877-805-5312.
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Non-completion of required forms
If you do not fill out the required forms, states will be able to remove you from Medicaid. It is important to complete your renewal before the due date to avoid losing your Medicaid benefits. You will have at least 30 days to fill out the form, and during this time, additional efforts will be made to encourage you to return your completed form. If you miss your due date, you will receive a courtesy renewal form follow-up letter reminding you to return your completed form by the extended due date.
To renew your Medicaid benefits, you can go to abe.illinois.gov and select "Manage My Case," mail your form according to the instructions in the letter, or call 800-843-6154. It is recommended that you renew your benefits as soon as possible, as everyone's renewal date is different. If you have Medicaid and other benefits, such as cash assistance or SNAP, you may need to fill out a redetermination form at the DHS office servicing your case.
If you are a Medicaid provider, revalidation has begun, and those who do not complete the process risk disenrollment. It is important to check your account to learn when your revalidation is due.
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Ineligibility for Medicaid
In Illinois, Medicaid is available to people who fall within certain categories. If you no longer meet the criteria for any of these categories, you will be ineligible for Medicaid. Here are some reasons why you may become ineligible for Medicaid in Illinois:
Income Changes
Medicaid is available for low-income people and families. If your income increases and surpasses the eligibility threshold, you may become ineligible for Medicaid. The income limits vary based on the specific category of Medicaid coverage, such as for adults, children, pregnant women, or adults who are disabled, blind, or aged 65 or older.
Change in Citizenship Status
To be eligible for Medicaid, you must be a U.S. citizen or fall within certain categories of non-citizens, such as refugees, asylees, or lawful permanent residents. If your citizenship status changes and you no longer meet the eligibility criteria, you may become ineligible for Medicaid.
Failure to Complete Required Forms
If you do not complete and return the required forms by the end of the specified reinstatement period, your Medicaid coverage may be terminated. It is important to stay up to date with any necessary paperwork to maintain your eligibility.
Age-Related Criteria
Medicaid coverage for young adults under the “All Kids" program is available until the age of 18. Once a person reaches the age of 18, they may no longer be eligible for Medicaid under this specific category. Similarly, the ACA Adults category provides coverage for adults aged 19 through 64 who do not have dependent children under the age of 18 living with them. If a person's circumstances change, and they no longer meet the age-related criteria for these categories, they may become ineligible for Medicaid.
If you find yourself ineligible for Medicaid due to any of these reasons or other factors, it is important to explore alternative health insurance options to ensure continuous coverage. You can visit GetCovered.Illinois.gov to shop for quality, affordable coverage provided under the Affordable Care Act (ACA). Additionally, even if you are not eligible for Medicaid, you may still qualify for financial assistance to help you afford coverage through the Health Insurance Marketplace.
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Failure to renew before the due date
In Illinois, Medicaid is an important part of overall health insurance enrollment and coverage, with about 3.9 million people covered under it. It is a government-funded, comprehensive health insurance program for low-income people that is funded by the state and federal governments.
To maintain Medicaid coverage, it is essential to renew your application before the due date. Renewal ensures that there is no interruption in your benefits, and you can continue to access no-cost medical, dental, vision, and mental healthcare. However, failure to renew your Medicaid coverage by the due date may result in termination of your insurance.
The renewal process for Medicaid in Illinois is annual, and everyone's renewal date is unique. It is the responsibility of the individual to be aware of their renewal date and take the necessary steps to renew their coverage. You can check your renewal date by calling the HFS Automated Voice Response System (AVRS) at 1-855-828-4995. This service is accessible 24 hours a day and is available in English and Spanish. To use this service, you will need your Recipient Identification Number (RIN), which can be found on your HFS-issued medical card or Managed Care Plan insurance card.
If you miss your renewal date, your Medicaid coverage may be terminated, and you will need to reapply. In the case of a missed renewal, you may be able to connect to alternative coverage options, such as work-based health plans or seeking assistance through Get Covered Illinois, which offers quality and affordable coverage under the Affordable Care Act.
To avoid missing your renewal date, it is recommended to update your address with Illinois Medicaid and watch your mail for any correspondence regarding your renewal. Additionally, you can utilize the Manage My Case online portal to stay informed about your benefits and manage your case information.
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Lack of timely notice of termination
It is important to keep your contact information up to date with the State of Illinois to receive timely and accurate information regarding your Illinois Medicaid coverage. Every enrollee will receive a letter from the State of Illinois regarding their renewal. This notice will come in a yellow envelope with red text that reads, "Action Required". It is important to complete the required renewal form to avoid losing coverage.
If you are no longer eligible for Medicaid, it is important to quickly get other health insurance to avoid a lapse in coverage. You can ask your employer if health insurance is offered, or you can visit Getcovered.illinois.gov to shop for quality, affordable coverage provided under the Affordable Care Act (ACA). You usually have 30-60 days to enroll in a new plan. This is called a "Special Enrollment Period".
You will be terminated from Medicaid if you don’t complete and return the required forms by the end of the 90-day reinstatement period. Members who are non-eligible will be removed from Medicaid and must enroll in an alternate health plan for coverage.
To renew your Medicaid benefits, go to abe.illinois.gov and select "Manage My Case", mail your form according to the instructions in the letter, or call 800-843-6154.
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Frequently asked questions
There are a few reasons why your Illinois Medicaid insurance may be terminated. One of the most common reasons is failing to submit eligibility information or failing to complete and return required forms by the deadline or the end of the 90-day reinstatement period.
If you lose your Medicaid coverage, you may be eligible for a Special Enrollment Period (SEP) to purchase a new health plan. You usually have 30 to 60 days to enroll in a new plan.
If you're not sure whether your Medicaid coverage has been terminated, you can visit abe.illinois.gov or call the Department of Human Services Helpline at 800-843-6154 for more information and assistance.
