Medicaid Renewals (Redeterminations): Keeping Long-Term Care Coverage

Getting approved for Long-Term Care Medicaid is not the end of the paperwork. States must check, at least once a year, that each person still qualifies. This review is called a renewal or redetermination. For people in nursing homes or receiving waiver services, losing coverage at renewal, even briefly, can mean unpaid bills, a gap in home care or a discharge notice. This guide explains how renewals work, what the state checks, how to respond, and what to do if coverage ends.

Figures change periodically. Double-check current amounts before relying on them.

How often renewals happen

For people who qualify for Medicaid on the basis of age, blindness or disability, which includes most people receiving Long-Term Care Medicaid, federal rules require a renewal once every 12 months, and generally no more often unless the state receives information about a change. States may also review eligibility at any time when a change is reported or found through a data match.

Ex parte renewals: renewal without a form

Before sending a renewal form, states must first try to renew coverage using information they already have or can get electronically, such as Social Security records, bank data from the Asset Verification System and other state records. This is called an ex parte renewal. If the state can confirm that the person still qualifies, it must renew coverage and send a notice, without asking the family to fill out a form. For people with very stable finances, such as a nursing home resident whose only income is Social Security and whose bank balance stays low, ex parte renewals are common.

Renewal forms

If the state cannot renew using the data it has, it sends a renewal form, often prefilled with the information it already has. Federal rules require states to give people at least 30 days to return the form for people in the age, blind or disabled groups. The form usually asks about:

current income from every source;
current balances of every account;
any change in assets, such as an inheritance, a sale or a new account;
any transfers since the last review;
changes in living arrangements or marital status;
health insurance changes.

You may be asked for recent statements or award letters. Answer every question and return the form, and any documents, before the deadline.

Common reasons coverage ends at renewal

The form was not returned. By far the most common reason. Forms are often mailed to an old address, or to a resident who cannot handle mail.
Documents were missing. Like an application, a renewal can end for failure to provide verification.
Assets grew over the limit. Monthly income that is not spent can build up in a bank account. For a nursing home resident, that can happen if the patient liability is not being paid, or if a refund or a back payment arrives. For a waiver participant, savings can grow slowly over time.
A change was not reported, such as an inheritance, a life insurance payout or the sale of property.
The spouse at home has not received the protected assets. In many states, the transfer of the spouse’s protected share into their name must be completed by the first renewal; if not, the assets may count against the resident.
A Miller trust was not used correctly. In income-cap states, income must be deposited into the trust every month and paid out according to the rules.

How to stay on top of renewals

Make sure mail reaches the right person. If the person is in a nursing home or cannot manage mail, request that notices go to the authorized representative or power of attorney. Update the address after any move.
Mark the renewal month. Renewals usually come about 12 months after approval. Many states send the form 45 to 60 days before the renewal date.
Keep a renewal folder with the current year’s award letters, the last few months of statements and copies of last year’s renewal.
Watch the asset balance. Check the account balance monthly, and plan allowed spending if it approaches the limit. See Allowed spend-down.
Report changes promptly, within the time your state requires (often about 10 days). See What happens if I forget to report a change?.
Return the form early and keep proof that it was sent.

If coverage ends

Read the notice. It should explain why coverage ended and how to appeal.
Ask about the reconsideration period. If coverage ended because the renewal form or documents were not returned, federal rules require states to reconsider eligibility, without a new application, if the form is returned within 90 days after coverage ended (some states allow longer). Coverage may be restored back to the end date if the person still qualifies.
Request a fair hearing if you believe the state made a mistake. If you request it before the termination takes effect, benefits may continue during the appeal. See Fair hearings.
Reapply if necessary. If the reconsideration period has passed, file a new application. Ask about retroactive coverage to cover the gap.
Tell the nursing home or care provider right away, so they know coverage is being restored.

Renewal and the spouse at home

At the first renewal, many states check that the assets protected for the spouse at home have been moved into the spouse’s name. After that, the spouse at home’s own assets generally do not affect the resident’s eligibility, even if they grow. The spouse at home’s income may still be reviewed if they receive a spousal income allowance from the resident’s income. If the spouse at home’s own circumstances change (for example, their income drops or their housing costs rise), they can ask for the allowance to be recalculated. See MMMNA.

Renewal and the patient liability

The state recalculates the patient liability whenever income changes. Social Security and many pensions rise each January with cost-of-living adjustments, and Medicare premiums change too, so the liability often changes at the start of the year even if nothing else does. Check new notices and update payments to the nursing home.

Changes that must be reported between renewals

Report these as soon as they happen:

a change in income (a new pension, a raise, an increase in a VA benefit);
an inheritance, lawsuit settlement, insurance payout or gift received;
the sale or transfer of property;
a new bank account;
a move to a different facility, county or state;
a hospital stay or a return home;
marriage, divorce or death of a spouse;
changes in health insurance.

Recent changes to watch

Federal legislation enacted in 2025 changed several Medicaid rules over the next few years. For example, it requires renewals every six months for adults in the Medicaid expansion group starting with renewals after December 31, 2026. Most people receiving Long-Term Care Medicaid are in the age, blind or disabled groups, and for them the annual renewal rule continues to apply. States may adjust their procedures as the new rules take effect, so read every notice.

A worked example

Evelyn has been on nursing home Medicaid for a year. Her renewal form is mailed to her old apartment, which her daughter emptied months ago, so no one sees it. Coverage ends on March 31 for failure to return the form. The nursing home’s business office notices in April and tells the daughter. She calls the agency, updates the address to her own as authorized representative, and returns the completed renewal form with current statements on April 20, within the 90-day reconsideration period. The state restores Evelyn’s coverage back to April 1, without a new application. The daughter also asks the agency to send all future notices to her, and puts next year’s renewal month on her calendar.

Had the daughter not learned about the termination until July, the reconsideration period would have passed, and Evelyn would have needed a new application, with only limited retroactive coverage to fill the gap.

Getting experienced help

Renewals look routine but often go wrong when a family member who handled the application is no longer involved, or when assets slowly build up over the limit. A Certified Medicaid Planner can handle renewals, keep the asset balance in check, make sure the spouse at home’s protected share is transferred on time, and respond if coverage is threatened. As a rough guide, hourly help ranges from about $150 to $600, and some professionals offer an annual flat fee for renewals.

Frequently asked questions

Will the nursing home handle the renewal? Some facilities help, especially if a staff member is the authorized representative. Do not assume they will; ask.

What if the person’s balance is just over the limit at renewal? Plan allowed spending before the renewal month, such as clothing, a hearing aid, dental work or prepaying an irrevocable funeral plan, so the balance is under the limit at the start of the month.

Do I have to report small changes in Social Security? The state usually learns about annual Social Security changes electronically. Report other income changes yourself.

Can coverage end for an unreported inheritance? Yes, and the state may seek repayment of benefits paid while the person was over the limit. See Inheritance.

Last updated for 2026. General information only, not legal or financial advice. Medicaid Answers is a free educational resource published by Medicaid Answers Foundation.