In March 2020, the federal government declared a COVID-19 public health emergency (PHE). The PHE allowed states to provide continuous Medicaid coverage for most people enrolled in Medicaid for more than two years. As of March 31, 2023, however, continuous Medicaid eligibility for some adults and children will end and you may have to re-establish eligibility. Starting on April 1, 2023, Texas Medicaid will resume Medicaid and Children’s Health Insurance Program (CHIP) eligibility reviews or redeterminations. As a result, some people with Medicaid or CHIP could be disenrolled from these programs.
Below are some things you can do to prepare, some options if you no longer qualify for Medicaid or CHIP, and some organizations that may be able to help you.
Make sure your address is up to date.
Make sure Texas Medicaid has your current mailing address, phone number, email, or other contact information. This way, they will be able to contact you about your Medicaid or CHIP coverage. You can review and update all of your personal information with Texas Medicaid by calling 2-1-1 or logging into YourTexasBenefits.com account.
Check your mail and YourTexasBenefits.com account.
Texas Medicaid will be mailing you a letter about your Medicaid or CHIP coverage. These “renewal notices” will be mailed in a yellow envelope that says “Action Required” in red or will be sent electronically to those beneficiaries who signed up for electronic notices. You will need to complete and return the renewal packet or request for information on time. You must be given a minimum of 30 days to respond to renewal packets or requests for information.
What do I do if Texas Medicaid incorrectly determines that I do not qualify for Medicaid or CHIP?
If you believe Texas Medicaid’s decision that you no longer qualify for Medicaid or CHIP is wrong, you can request a Medicaid Fair Hearing to contest this decision. You should get a written notice explaining why Texas Medicaid claims you no longer qualify. While you have 90 days from the date of the denial notice to request a Fair Hearing, if you request the Fair Hearing within 10 days of the date of the denial notice, your Medicaid or CHIP coverage will continue until a hearing is held and the hearings officer issues the decision. This continuation of benefits pending the hearing decision is an important protection against the immediate loss of Medicaid eligibility.
What other options are available if I do not qualify for Medicaid or CHIP?
If Texas Medicaid correctly determines that you no longer qualify for Medicaid or CHIP or you lose your fair hearing, there are options you can consider.
You may be able to buy a health plan through the Health Insurance Marketplace. Losing Medicaid or CHIP coverage is a Qualifying Life Event (QLE), which allows you to enroll in a Marketplace plan outside of the Open Enrollment Period. Visit HealthCare.gov or call the Marketplace Call Center at 1-800-318-2596 (TTY: 1-855-889-4325) to get details about Marketplace coverage. Four out of five former Medicaid beneficiaries can find plans that cost less than $10 per month. To apply, you will need current information about your household, income, and Texas Medicaid’s decision about your Medicaid or CHIP coverage.
You may be able to sign up for Medicare without paying a late enrollment fee. If you now qualify for Medicare, but did not sign up for it when you first became eligible, you have a limited time (the “Special Enrollment Period”) to sign up without paying the usual penalty. Your Special Enrollment Period starts the day Texas Medicaid notifies you that your Medicaid coverage is ending and continues for 6 months after your Medicaid coverage ends. To sign up for Medicare during this Special Enrollment Period, fill out a CMS-10797 Form and mail or fax it to your local Social Security Office. You can also call Social Security at 1-800-772-1213. TTY users can call 1-800-325-0778.
What other options are available if my child no longer qualifies for Medicaid?
You may be able to obtain health care coverage through the CHIP program or the Medicaid Buy-In for Children (MBIC) program.
To apply for CHIP, visit YourTexasBenefits.com to access the application, or you can apply by phone by calling 2-1-1, picking a language, and then pressing 2. A Texas Health and Human Services Commission (HHSC) representative will then help you with your application over the phone and mail it to you to sign.
For more information about the Medicaid Buy-In for Children program, and to apply, visit the Medicaid Buy-In for Children webpage.
For more information on the Medicaid and CHIP renewal process, visit Get Ready to Renew Your Medicaid or CHIP Coverage.
If you need assistance with the Medicaid renewal process, you can:
This article provides information on health insurance for children in low-income families in Texas.
This article discusses dealing with denials or reductions of children's Medicaid services.
This article discusses options when trying to secure healthcare when you do not have health insurance.