How to Handle Renewals?

What Is Medicaid Renewal and How Often Does It Happen?

Medicaid Renewal — also called redetermination or recertification — is a regular review to confirm that a beneficiary still qualifies for Medicaid benefits. This applies whether a person is on Regular State Plan Medicaid, receiving Home and Community Based Services (HCBS) through a waiver, or enrolled in Nursing Home Medicaid. The process ensures income and assets remain within state limits, so long-term care coverage can continue. Every state requires recipients to report any life changes that could affect eligibility, such as higher income, new assets, or changes in household composition. These must typically be reported within 10 to 30 days, even if it’s not time for the annual renewal. Failing to do so could result in benefit loss, repayment demands, fines, or even criminal penalties. By federal rule, Medicaid renewal for seniors and people with disabilities occurs at least once every 12 months, though states may require it more often.

What Does the Medicaid Agency Check During Renewal?

When renewing, the Medicaid agency reviews financial information to verify that income and countable assets remain under the state’s eligibility limits. They may also check if assets ever went over the limit during the year. This review can include bank account statements, tax returns, pension records, home equity values, and other financial documentation. California is an exception — it no longer enforces an asset limit as of January 1, 2024. For nursing home residents or those receiving HCBS through a waiver, the spouse’s income and assets are generally not factored into the renewal calculation. Information that doesn’t change — like age, Social Security number, and citizenship — usually doesn’t need re-verification.

What Does the Beneficiary Need to Do?

In some cases, beneficiaries may not need to submit anything — states can sometimes renew coverage entirely through electronic data checks. In others, the Medicaid office will require a completed redetermination form, provided by paper, online portal, or in person. Additional proof of income or resources may be required. Examples of acceptable proof:

• Income: SSI or VA benefit award letters, pension statements, tax forms, or self-declaration letters when no other documentation exists.
• Assets: Bank statements, retirement account summaries, life insurance policy details, or proof of home/car equity changes.

How Does the Medicaid Renewal Process Work?

The federal renewal framework outlines several methods, but states have flexibility in how they apply them, especially for seniors.

What Is Automatic Renewal?

Also called Ex Parte Renewal or Administrative Renewal, this process uses electronic data sources to confirm ongoing eligibility. If the state finds no changes, they can renew coverage without contacting the beneficiary. Automatic renewal is not possible if certain income sources (like rental or self-employment income) can’t be verified electronically, or if no Social Security number exists for cross-checking. In those cases, the agency must request paper documentation.

What Is a Pre-Populated Renewal Form?

If automatic renewal isn’t possible, some states send a form with pre-filled known information — beneficiaries only add missing or corrected details. This is more common for MAGI groups (children, certain adults, pregnant women) and optional for seniors, nursing home residents, and waiver recipients. The completed form must be signed, dated, and returned with any requested documentation. States must give at least 30 days to respond, and some allow submission online, by phone, or in person.

Does the Process Vary by State or Program?

Yes. The process differs depending on the Medicaid eligibility group and whether it’s a MAGI or non-MAGI category. MAGI rules — standardized under the Affordable Care Act — apply mainly to children, certain adults, and pregnant women. Non-MAGI rules apply to seniors, people with disabilities, SSI recipients, and those needing long-term care, including nursing homes.

What Happens If You Miss the Renewal Deadline?

If renewal isn’t completed on time, Medicaid coverage stops. Federal rules allow 90 days from closure to submit the necessary information and have coverage reinstated without a new application, if eligibility still exists. Some states offer retroactive coverage for medical costs incurred during the lapse. If no action is taken within 90 days, the person must reapply, often resulting in a coverage gap.

Where Can You Get Help With Medicaid Renewal?

Free assistance: Public Benefits Counselors or Case Managers at Medicaid agencies, Aging and Disability Resource Centers, and Area Agencies on Aging can help with form completion and documentation — but only if the person still meets eligibility criteria. Paid assistance: Certified Medicaid Planners and Elder Law Attorneys often offer renewal services for an annual fee, typically $1,500 – $3,000, especially for clients they helped initially. This can be useful for complex cases or when eligibility is at risk. Click here to connect with a Medicaid Renewal Specialist for personalized guidance.