If you are a Medicaid beneficiary, nothing is as disturbing as finding out your insurance is inactive. If your Medicaid insurance becomes inactive, you may have stopped being able to receive healthcare services, fill prescriptions, and receive basic medical care. The question is, why is my Medicaid insurance inactive? This is one that many Medicaid recipients will ask at some point. The answer is complex, but it is important to know why an inactive Medicaid policy exists and how to respond to avoid gaps in coverage where they shouldn’t be.

This article will explain the most likely causes of your Medicaid insurance becoming inactive, what to do if it becomes inactive, and how to keep your coverage active in the future.

What Does Inactive Medicaid Insurance Mean?

Inactive Medicaid insurance is when your coverage has been suspended or ended. However, this could happen for several reasons, which we’ll go into shortly. Inactive Medicaid policy is when you no longer have access to the benefits you used to have including doctor visits, hospital stays, and prescription medications, as well as other essential healthcare services.

If your Medicaid insurance is no longer active, your state Medicaid office will usually send you a letter notifying you why the coverage was stopped. The notice will tell you what steps you need to take to fix the problem and, in many cases, reactivate your coverage.

It’s important to know why your Medicaid insurance is active and what you should do about it because you don’t want to be interrupted by your healthcare services. Looking at the reasons why your Medicaid coverage is inactive may help.

Common Reasons for Medicaid Insurance Becoming Inactive

Your Medicaid insurance could become inactive for several reasons. Below are some of the most common causes:

1. Failure to Renew Your Medicaid Coverage

To be covered by Medicaid means that you periodically need to renew your coverage to make sure you still qualify. Renewals may occur annually or at other intervals and may depend on your state. If you don’t renew your Medicaid insurance on time or don’t supply the needed documentation, your Medicaid insurance can go inactive. It could be as simple as not submitting the paperwork or missing a deadline.

Well in advance renewal notices are usually sent out, but it’s important to keep on top of your renewal schedule and respond promptly to not lose cover.

2. Changes in Income

Your income, your household size, and other factors all help determine whether or not you’ll be eligible for Medicaid, and those factors can change over time. Income may change (such as getting a new job, receiving a raise, or adding a new family member) or your household situation may change (such as living with a roommate or spouse) and you may no longer be eligible for Medicaid.

If your income is above the Medicaid threshold, you could lose your coverage and your insurance could become inactive. If you change your income it’s important to notify your Medicaid office so you don’t lose coverage unexpectedly.

3. Medicaid Requests for Information that went unheeded.

You may have to maintain regular status updates of your eligibility to be able to maintain Medicaid coverage. If you don’t respond to a request for information or don’t provide the required documentation, Medicaid may suspend or make your coverage inactive. In these cases, these requests could be for updated income, proof of citizenship or residency, and changes in household composition.

You need to always respond to Medicaid’s request for information and keep your file up to date to prevent this.

4. Aging Out of Medicaid

Rules for which people are eligible for Medicaid depend on age. However, some people lose Medicaid coverage at a certain age. For example, if a child is covered under his or her parents’ Medicaid plan, when the child turns 18 or 21 in some states, depending on the state’s rules, he or she loses coverage. Similarly, young adults who age out of Medicaid, for instance, if they turn 26, or another age threshold, their insurance can go inactive.

If you are coming up to the age where you may no longer be eligible, it’s a good idea to look into alternative insurance options like Medicaid expansion programs, the ACA Marketplace, or employer-sponsored insurance.

5. Changes in Family Status

Often, eligibility for Medicaid is based on family size and other household conditions. Changes in your family such as a divorce, birth of a child, or loss of a family member can also result in a change of Medicaid coverage. If you don’t report these changes promptly, your Medicaid coverage may become inactive because the state will no longer see you as being eligible.

If your household situation changes, you want to let your state Medicaid office know right away so you don’t have a disruption in coverage.

6. Moving to a Different State

Each state has its own Medicaid eligibility rules, and Medicaid is administered at the state level. If you move out of your state, you may no longer be eligible for Medicaid in your home state. That means your insurance will be inactive, and you’ll have to sign up for Medicaid in your new state.

If you’re moving to a different state, call both your current and new state Medicaid offices to make sure you won’t have a coverage gap.

7. Changes in Medicaid Program Requirements

The state and federal levels of policy can change Medicaid programs. These changes may or may not affect eligibility. For instance, income limits change, or certain medical services may no longer be covered. Your coverage may be deactivated if you no longer meet the program’s updated requirements.

It is important to be informed about what changes in Medicaid eligibility and benefits are happening in your state so you don’t lose coverage when you don’t expect it.

What to Do If Your Medicaid Insurance Becomes Inactive

If your ‘Medicaid insurance’ is inactive, it’s best idea to remedy the situation as soon as possible. If reactivation is not possible or you don’t qualify to renew your Medicaid coverage you can take the steps listed below to reactivate your Medicaid coverage or explore other options.

1. Call or contact your state Medicaid office.

First, you should contact your state Medicaid office. This is a state-administered program, so rules and processes for reactivating may differ by location. Contact the office that handles your mediation to learn why coverage was deactivated and what you need to do to bring it back.

If you are contacted by the Medicaid office, be ready to give the details of your personal information like name, date of birth, and Medicaid ID number. If the deactivation was because you didn’t provide the documentation or renew your coverage, it may be possible to rectify the problem by simply submitting the necessary forms.

2. Submit Required Documentation

But if your Medicaid coverage lapsed because you didn’t renew on time or didn’t put in the needed details to support your coverage, you may have to submit the right documents to get your coverage reactivated. The type of inactivation may dictate that you must provide income verification, proof of residence, or some type of personal information.

It is important to follow the instructions given by your state Medicaid office very carefully. If you submit incorrect documents, the package may delay the reactivation process.

3. Apply for Medicaid in New State (If You Moved)

Medicaid from your previous state will likely no longer be active if you’ve recently moved to a different state. For you to have continuous coverage, you’ll want to apply for Medicaid in your new state. The application process varies from state to state, so you’ll have to speak with the new state’s Medicaid office to start applying for coverage.

Remember to apply for Medicaid and to ensure all your health insurance needs are covered, as soon as you move. In other words, if you can, you might have previous Medicaid coverage that you can use in the meantime, but your new state will have Medicaid coverage, and you’ll need to rely on that until it becomes inactive.

4. Have a Look Around for Alternative Health Insurance Options

If you can’t or aren’t able to get reactivated for your Medicaid coverage, there are other ways to get health insurance. There are several ways that you could qualify for an ACA Marketplace plan, an employer-sponsored health insurance plan, or short-term health insurance coverage.

In some cases, you may qualify for premium subsidies or cost-sharing reductions through the ACA Marketplace that can make you pay less for private health care insurance. If you can’t meet the eligibility criteria for any government assistance programs, you should consider the health insurance plans that individuals provide.

5. Inactivation Decision appeal

If you don’t agree with their decision to take your Medicaid coverage away, you can appeal. If you’re a Medicaid recipient, you can generally appeal a termination or when you didn’t get enough notice that your coverage has been denied.

To appeal a decision, contact your state Medicaid office to find out how to file that appeal and what information you will need to provide. And, mind you, the appeal process can take some time and money.

What can you do to prevent future Medicaid inactivation?

To avoid the stress and inconvenience of Medicaid inactivation in the future, consider taking the following steps:

1- Stay on top of renewal dates: You’ll want to find out your Medicaid renewal schedule and make sure you turn in the required documentation on time.

2- Report any changes promptly: If you change your income, housing, or resident status, notify your state’s Medicaid office.

3– Monitor Medicaid policy changes: Keep up to date about changes in Medicaid eligibility rules and benefits in your state to stay covered.

Conclusion

Finding out that your Medicaid insurance has gone inactive can be scary, but knowing why it has gone inactive and how to reactivate your coverage is important to experiencing less of a disrupting event due to your healthcare service. You can move through the process and stay covered, by contacting your state Medicaid office, submitting the required information, and looking at other health insurance options, if necessary.

But by remaining proactive and informed about when and about what you need to do to maintain your eligibility for Medicaid, and also to renew your Medicaid benefits for future coverage, you won’t have any gaps in coverage in your future.