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Medicaid renewal and redetermination

Medicaid redetermination is also called Medicaid renewal or Medicaid recertification. It’s when people who have Medicaid benefits are asked to show they still qualify to get Medicaid in their state.1

Starting in 2027, some Medicaid members may need to renew their Medicaid coverage every 6 months. Some adults may need to show that they are working, going to school, job training or helping in their community.2 3

Read on to learn how Medicaid renewal works and what you can do next.

What is Medicaid redetermination?

Medicaid redetermination is when the state checks if you still qualify to get Medicaid benefits.1 Your coverage will renew only if the state can confirm that you still qualify.

  • In some cases, the state can do this automatically. This is because it already has the information it needs.
  • If the state cannot renew your coverage on its own, it will request more information.
  • If the state decides you no longer qualify, your coverage will end. It can also end if you don’t respond to a renewal notice.4

Medicaid redetermination requirements

Medicaid renewal usually follows a few steps. Here’s what to expect and how to be ready.

Receive a renewal notice

About 60 to 90 days before your coverage ends, your state will send you a renewal notice. It may come by mail or email. If your state offers an online portal for Medicaid coverage, you can check your online account for any renewal notices. Make sure your address, email and phone number are up to date to make sure you don’t miss this important notice.5

Some states renew coverage automatically. They use information like tax or Social Security records. This is called ex parte renewal. Also called administrative, passive or auto-renewal, ex parte renewal is when a government agency — most commonly Medicaid or the Children's Health Insurance Program (CHIP) — renews your coverage without requiring you to fill out forms or submit new documents. If your state can’t verify your information this way, you will get a form to fill out.5

Complete the renewal form

If your state sends a form, fill it out and return it by the deadline. The form may ask you to confirm or update:5

  • Who lives in your household
  • Monthly income for adults in the household
  • Your address and contact information
  • Changes to your health insurance (For example, if anyone in your household has access to other health coverage, such as a plan offered through an employer)

Most states let you renew online. Log in to your state’s benefits portal to complete the form.

Submit documents

If your income or household has changed, your state may ask for documents such as:5

  • Recent pay stubs
  • Benefit letters, such as Social Security or unemployment
  • Your recent tax return
  • Proof of your new address, if you moved

If nothing changes, your state may ask you to confirm your information.

Receive a renewal decision

After you send your renewal, the state will review it and send you a decision. If you still qualify, your coverage will continue. If you don’t qualify, you’ll get a notice explaining when your coverage will end and how to appeal.5

New Medicaid rules for renewal and work requirements

Starting in 2027, some adults in Medicaid expansion programs will need to renew coverage every 6 months instead of once a year.1

Some pregnant people, older adults and people with disabilities will still renew once a year.6

Also starting in 2027, some adults may need to meet a work rule to get or keep Medicaid. This may apply to some adults aged 19 to 64.4

You may meet this rule by working, going to school, getting job training or doing community service. In most cases, you need to complete 80 hours each month.3

Some people do not have to follow this rule. This may include people who:3

  • Recently gave birth or are pregnant
  • Have serious health needs
  • Care for a child aged 13 or younger
  • Care for a person with a disability

States may give short-term exceptions. This can include a hospital stay, a disaster or high unemployment in your area.3

If the state can't confirm that you meet the requirements, it may give you time to respond. If you lose coverage, you may be able to apply again.3

Rules can vary by state, so check your state's Medicaid program for details.

When is Medicaid renewal?

Your Medicaid renewal date depends on when you first signed up or last renewed your benefits. It is different for each person.5

You can find your renewal date by:5

Your state must send at least one renewal notice before your coverage ends. If you do not get one, contact your state right away. You still need to renew on time.5

Medicaid plan benefits can change depending on where you live. Choose your state to learn more about Medicaid benefits where you live.

Does Medicaid automatically renew?

States check their records to see if you still qualify for Medicaid. If they can, they will renew your coverage automatically. This is called automatic renewal or ex parte renewal.4

Automatic renewal is not always possible. Some income may not show up in their records. If the state can't prove your information, it may ask you to send more documents.4

When is Medicaid renewal?

Your Medicaid renewal date depends on when you first signed up or last renewed your benefits. It is different for each person.5

You can find your renewal date by:5

Your state must send at least one renewal notice before your coverage ends. If you do not get one, contact your state right away. You still need to renew on time.5

Medicaid plan benefits can change depending on where you live. Choose your state to learn more about Medicaid benefits where you live.

Does Medicaid automatically renew?

States check their records to see if you still qualify for Medicaid. If they can, they will renew your coverage automatically. This is called automatic renewal or ex parte renewal.4

Automatic renewal is not always possible. Some income may not show up in their records. If the state can't prove your information, it may ask you to send more documents.4

How to renew Medicaid

Renewing Medicaid may be easier than applying for the first time.

Online

This is typically the fastest method. The process may vary slightly by state. You can typically renew online through your state’s benefits portal. Keep your confirmation number in case you need it later.5

By phone

Call your state Medicaid helpline. A caseworker may be able to help you renew over the phone. Have your Medicaid ID number, income and household information ready.5

By mail

If your state sent you a paper form, fill it out, sign it and mail it to the address on the form. If your deadline is close, use certified mail so you have proof you sent it.5

In-person

Visit your local Medicaid office or a community health center. Staff can help you complete your renewal.5

What happens if you don’t renew in time?

Missing the renewal deadline does not always mean you lose coverage for good.5

  • Many states give you 90 days after your coverage ends to renew. If you still qualify, your coverage may be restored.5
  • If you renew within 90 days, many states will restart your coverage from the date it ended. Bills from that gap may still be covered.5
  • You could appeal if your coverage ended, and you think you are still qualified. Many states give you 90 days to ask for a hearing.5
  • If too much time has passed, you can apply again. Coverage often starts the first day of the month you apply. In some cases, coverage can also start before the month you apply, if you were eligible. Check your state's Medicaid program for details.5

Medicaid renewal mistakes to avoid

These are some common reasons Medicaid renewal does not go through:6

Not answering the renewal notice

  • Even if nothing changed, you still need to respond
  • If your address, email or phone number is not up to date with your state, you may miss an important notice

Missing information

  • If the state asks for proof of income or other documents, send them as soon as you can

No longer qualifying for Medicaid

  • Check your state’s income limits to see if you still qualify
  • Changes in your household, such as marriage, divorce, someone moving in or out or a child aging out of coverage

What can you do if you no longer qualify for Medicaid?

If your state says you no longer qualify for Medicaid, your coverage may end.6

If that happens, your state may share your contact information with the ACA Marketplace. The Marketplace (also called the Exchange) is where ACA health plans are sold. The Marketplace may contact you by mail, phone, text or email. You do not need to wait to apply for a new health plan.6

You may be able to get Marketplace coverage with savings if you:6

  • Lost Medicaid or CHIP
  • Will lose Medicaid or CHIP soon
  • Applied through your state and were denied

If you lose Medicaid because you did not meet work requirements, you may not qualify for Marketplace savings called premium tax credits.

If your state says you no longer qualify, you can apply again at any time.6

Learn more about Medicaid plan benefits where you live by selecting your state.

What can you do if you no longer qualify for Medicaid?

If your state says you no longer qualify for Medicaid, your coverage may end.6

If that happens, your state may share your contact information with the ACA Marketplace. The Marketplace (also called the Exchange) is where ACA health plans are sold. The Marketplace may contact you by mail, phone, text or email. You do not need to wait to apply for a new health plan.6

You may be able to get Marketplace coverage with savings if you:6

  • Lost Medicaid or CHIP
  • Will lose Medicaid or CHIP soon
  • Applied through your state and were denied

If you lose Medicaid because you did not meet work requirements, you may not qualify for Marketplace savings called premium tax credits.

If your state says you no longer qualify, you can apply again at any time.6

Learn more about Medicaid plan benefits where you live by selecting your state.


Disclaimer information

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Looking for the federal government’s Medicaid website? Look here at Medicaid.gov.

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