Updated June 30, 2023

When COVID-19 arrived on the scene in spring 2020, it caused a lot of changes – including changes in the health insurance safety net for adults and children with low incomes.

So many people lost their jobs, or had their work hours cut, during 2020 that an emergency order went into place.

Under this special order, Medicaid, the Children’s Health Insurance Program, and other health insurance programs for low-income people temporarily stopped requiring people to prove every year that they still had low incomes. 

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This helped people keep their insurance coverage – both people who suddenly needed this kind of safety net insurance for the first time, and people who had received their insurance from these programs for a while.

In Michigan alone, more than two million people were able to have insurance during the pandemic and get care when they needed it. Nationally, the number is around 95 million.

Now that the pandemic has eased up, and jobs are easier to find, that emergency order ended on March 31, 2023. Some people are calling it an “unwinding" of pandemic-era rules; the official name is "redetermination."

This means that everyone in these programs will have to renew their coverage if they want to keep it, if they are still eligible for it. 

This process will take many months to complete. Every state may go about it slightly differently. Data from states that have begun their unwinding shows that more than 1.5 million people nationwide lost their Medicaid or CHIP coverage in the first few months -- many of them because they didn't submit required information. 

In Michigan, the process requires everyone covered by these kinds of insurance to provide income information to the state Department of Health and Human Services. The state is using that information, and information it receives directly from other sources, to figure out if each person or family still qualifies for those plans based on their income.

The state of Michigan has launched a website to help everyone understand what to expect and do. The state offers a timeline of what will happen month by month, and a list of Frequently Asked Questions as well as an overview video.

In late June, Michigan officials announced that they will allow people who don't submit information by their personal deadline an extra month to submit information before dropping them or their child from the Medicaid or CHIP program. So, people whose deadline was June 30 have until July 31 to finish submitting information, and so on.

We asked experts from Michigan Medicine and other organizations what all this means and what people with these kinds of insurance should be doing now, before the rollback of the emergency order starts.

1. Don’t panic.
   
   The state of Michigan, and many other states, will do this gradually, not all at once. In Michigan, there is a three-month period from the time a person will first be notified about the process starting for them, to the date when their eligibility will end or be renewed for a year. Each person's three-month period will be based on the month they first received Medicaid coverage. 
   
   The process will be different in other states, but each state's Medicaid office should offer information about timing and where to turn for help.

2. Act now to make sure the state has your correct address.
   
   Different states may have different plans for how they will contact people about what they need to do, and when they need to do it by. But no matter what, it's important to make sure your state has the right contact information for you.
   
   Each month from April 2023 to May 2024, the state of Michigan is sending out very important paper letters with instructions to the addresses they have on file for the people whose turn it is to go through review. So, it is crucial that you make sure your address is correct in their system. Log in to the MiBridges website to check the address on file for you. If you have chosen to get text messages from MiBridges, you will get a text message telling you that information is available in the online system and that you can go there to see it.

   If the address in the system for you is wrong, or if you have moved recently or will move soon, or if you’ve never received a paper letter from the state health department at your current address, put the right address in the system in both the ‘Profile’ and the ‘Report My Changes’ sections. Or call your case worker and give them your correct address. Or go to the state health office in your county, and do it in person.
   
   If you live in Michigan and you do not have a MiBridges account, or you need help with it, contact your county MDHHS office.

3. When you get a letter, act fast:
   
   In Michigan, the state is sending two letters to everyone in these programs for whom it has addresses. The first letter is for awareness that their redetermination process will start soon; the second one includes information about what they need to do to seek renewed coverage, and the deadline. In this second letter, each person or family will be asked to submit information about their current income, unless the state can get that information directly from other verified sources such as other state computer systems. 
   
   Some people, especially those who have both Medicare and Medicaid, may have to give more information about other assets like any houses, cars or bank accounts.
   
   You can submit information online through MiBridges, by mail, or by phone; see this page for more information.
   
   If you submit income information, the state will review it, and you will either get a letter saying you can continue in the program for another year, or a letter saying you have been determined not to qualify and your coverage will not renew.
   
   If you don’t get a letter because of a bad address, or you get it but you don’t submit information, you could lose your coverage. The state will send another letter saying you are being dropped from the insurance program at the end of the month that the letter was sent in.
   
   If you know that your income has gone up above the limit, you should still submit information that’s requested in the letter. Your coverage will continue until the state reviews your information and you get a letter saying your coverage will end at the end of the month.
   
   If you find out that your coverage is about to end, act fast again. You will have a limited time to sign up for health insurance through your employer (if they offer it), or through the Healthcare.gov Marketplace. If you miss this opportunity, you may not have insurance for the rest of 2023, though you may be able to buy a plan on the Marketplace (keep reading to learn more).

4. If you have a job that offers insurance, find out more about it now. Talk to your employer about how to enroll in it, either now or later. 
   
   Under national law, if you get a letter saying that you no longer qualify for Medicaid or other safety net coverage, your employer must open their plan up to you, even if it’s not the usual Open Enrollment time. You have 60 days to enroll.
   
   If you still qualify for Medicaid because of your income, but you also have access to insurance through a job, you can sometimes keep Medicaid as your secondary insurance, and use your job-related insurance for other costs.  

5. If you don’t have access to job-related insurance, but your income is now above the limit for “safety net” insurance, now is the time to look at what kind of insurance you could buy for yourself and your family.
   
   The Healthcare.gov website has a special Open Enrollment period through the end of 2025 for people with incomes under 150% of the federal poverty level.
   
   Even if your income is higher than that, losing insurance is always considered a “life event” that gives you access to buy a plan on the Healthcare.gov site.
   
   Depending on your income, you may qualify for financial help to pay for some of the costs of coverage from a plan you buy on Healthcare.gov. In fact, 4 out of 5 enrolled Americans are able to find health insurance through HealthCare.gov for less than $10 per month.
   
   Go to https://www.healthcare.gov/screener/ to find out if you can buy insurance now or soon on the Marketplace.
   
   Important: You can look at plans now, and get a sense of what kind of financial help you might get. But don’t complete the process of enrolling in this kind of coverage until you know that your income-based coverage is ending. You can start enrolling anytime in the 60 days before the date when you know your insurance is going to end, and in the 60 days after your insurance ends.
   
   If you turned 65 between March 2020 and spring 2023 while you had Medicaid coverage, and didn't enroll in Medicare yet: There are special rules for you about joining Medicare; see this information for Michigan residents.

6. If you have a doctor or other provider you especially want to keep seeing, or appointments or procedures scheduled for this year, make sure you check to see if they accept the insurance plan you might switch to.
   
   You can see which doctors and other providers, and which hospitals, are in network for each insurance plan by checking the plan’s website or calling them. 
   
   If you're in Michigan, contact the state health department at 1-844-464-3447 (1-844-4MI-DHHS). Their automated system, available in English, Spanish and Arabic, can help you understand You can also check the website of the clinic, health system or hospital you are planning to go to. For example, here’s the page of insurance plans that Michigan Medicine accepts for services at all University of Michigan Health hospitals and clinics. If you are shopping on the Marketplace, you can see the list of Marketplace plans that Michigan Medicine accepts here.

7. Don’t be afraid to ask for help:
   
   Major hospitals and county health departments offer help in navigating health insurance issues. In Michigan, the state is adding more staff to help people understand their options.
   
   If you’re in southeast Michigan you can contact the Washtenaw Health Plan at 734-544-3030 or [email protected].
   
   Michigan Medicine’s financial counselors can help anyone in Michigan; call them at 877-326-9155 between 8 a.m. and 5 p.m. Monday-Friday or send email to [email protected].
   
   Or use the Local Help section of healthcare.gov or contact a local safety net clinic to find help anywhere in the country.

8. If you get a new form of insurance, make sure to tell your doctor’s office or other places you get care.
   
   They need to update their records with information you give them. They won’t get a notice from the state if you are no longer covered by Medicaid or the Healthy Michigan Plan. They need to know where to send the bills for any care you receive.

9. Don’t just let your insurance lapse!
   
   Having an insurance gap can be very bad for your health. Studies have shown that many people without insurance delay seeking needed care because they will have to pay the full cost.
   
   What if you had an emergency and needed care right away? Or you had a symptom that you needed to get checked out? If you don’t have money saved up that you could use to pay for care directly, you could end up with big bills.
   
   Get at least some form of insurance to cover big costs – and things like COVID-19 testing and care if you need it.

10. If you have appointments or procedures scheduled in the next few months, or you need care now, your current plan should cover it. But that may change if your insurance ends or changes.
    
    Because the renewal process will be done gradually, you are covered by your current program until you learn otherwise. But this is why it is so important to make sure your address on file is correct, and you reply to any letter promptly.
    
    If you lose coverage because you didn’t get the letter or you didn’t provide the necessary information, and a hospital or clinic can’t get payment for services you receive, they will have to send you the bill.

Sources for this article:

• Alena Hill and Kerry Knous, who oversee a team of financial counselors who help patients get information about health insurance at Michigan Medicine, the University of Michigan’s academic medical center. 

• Kim Hulbert, who has the same role at Trinity Health St. Joseph Mercy Ann Arbor.

• Pooja Neiman, M.D., M.S., a health care research fellow at Michigan Medicine and surgical resident at Brigham and Women’s Hospital in Boston, Massachusetts who studies health insurance safety nets.

• Krista Nordberg and Meredith Buhalis at the Washtenaw Health Plan, which helps members of the community in Washtenaw County and beyond with insurance issues.

• The websites of the Michigan Department of Health and Human Services and the Michigan Department of Insurance and Financial Services, the federal Healthcare.gov website, and the Kaiser Family Foundation Medicaid page.

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