Illinois Medicaid and the end of continous coverage

Frequently Asked Questions about Illinois Medicaid and continuous enrollment

I.    Basics on Medicaid Continuous Coverage

II.   For Medicaid Members/Customers 

III.  For Healthcare Providers

IV.  For Advocates and Community Based Organizations and Media

A better question is: When will Illinois resume regular eligibility checks?

The first time anyone with Medicaid will get a renewal notice in the mail will be the start of May 2023. But that will only be for people whose coverage is due for renewal by June 1.

It is important to know that everyone's renewal date is different. Everybody else will keep their coverage until it is their redetermination month. There will be no "coverage cliff."

The next people to get renewal mail will be people due July 1; they will get their notice the first week of June. And so on throughout the year. Everyone will get their notice in the mail a month before their due date.

The best thing customers can do is be ready to renew.

1. Click Manage My Case at abe.illinois.gov to set up your online account
2. Verify your address is correct to make sure you get our mail (the address we have on file for you is in the 'Contact Us' tab)
3. Look up your due date so you know when to expect our letter (their due date is in your 'Benefit Details' tab)
   

What will happen when continuous coverage ends?

We must resume regular eligibility verifications, also known as renewals or redeterminations.

We will mail renewal forms to the head of household and authorized representative on the case, if there is one. If we have enough information about a customer to automatically renew them, their renewal form will tell them what information we used to determine their eligibility and ask for any corrections. If we need more information, the form will ask for more information. Medicaid customers will then have to submit their renewal, and we will check their eligibility. This process is called "redetermination," which will be the term used on the forms.

People will get their renewal forms one month before they are due, and all renewals are due by the first day of the following month. For example, if a person's renewal is due by June, they will get their renewal form the first week of May and must return it by June 1. People whose renewals are due in July will get a letter the first week of June and must return them by July 1, and so on.

If someone doesn't submit their renewal or doesn't qualify anymore, they may lose coverage a month after their renewal due date. So, for people whose renewal date is June 1, they may lose coverage as early as July 1.

Here is the timeline:

You can find your renewal date by clicking Manage My Case at abe.illinois.gov. Your due date is in your 'Benefit Details' tab.

Your renewal will be available about 1 month before your renewal is due. If it is time to renew your benefits, you will see a 'Renew My Benefits' button on your 'Case Summary' page.

It is important to know that everybody's due date is different. There will be no "coverage cliff" where everybody needs to renew all at once. We renew people all year.

What do I need to do to ensure I will receive my renewal letter?

Please, update your address with Illinois Medicaid today!

Medicaid pays for your healthcare, like visits to your doctor and your medicine. By updating your address, you can avoid surprises and get updates about your insurance.
You can go online to update your address at medicaid.illinois.gov or call 877-805-5312 for free from 7:45am – 4:30pm. If you use a TTY, call 1-877-204-1012.

What happens if I miss my due date?

We highly recommend you submit your renewal, even if you are late.

After you miss your renewal date, we will send you a letter telling you the date you will lose your Medicaid coverage. However, there is a chance that we can still renew you if you submit your renewal within 90 days of that date. We will review your case on an individual basis.

If you are reinstated, your Medicaid coverage will be retroactive back to your original renewal due date. That means we will pay for healthcare costs you had between your original due date and when we reinstated your coverage.

If you are more than 90 days late, you are required to reapply completely with a new application.

What if I am no longer eligible for Medicaid?

If you are no longer eligible for Illinois Medicaid, you will receive a letter that tells you:

• When your coverage ends
• How to appeal our decision
• Options for purchasing other health care coverage, such as through your employer or getcoveredillinois.gov, the official Affordable Care Act Health Insurance Marketplace for the state of Illinois, which offers free enrollment assistance and can help you find out if you may qualify for financial help. Many people find plans for $10 or less per month after tax credits.

 
If you are no longer eligible for Medicaid, it is important to quickly get other health insurance. You usually have 60 days to enroll in a new plan. This is called a "special enrollment period." Ask your job about health insurance or visit the official Affordable Care Act marketplace for Illinois at GetCoveredIllinois.gov. You can get free help singing up for a plan that meets your needs. Most people find a plan for $10 or less per month after tax credits.

What if I have other questions?

Log in and click Manage My Case at abe.illinois.gov, where you can send us a message, or call us at 1-800-843-6154.

We will need your help to make sure people who use Medicaid stay connected to coverage. Tell your customers to keep their address and contact information up to date with the state of Illinois by visiting abe.illinois.gov.

Please set up a system to help customers at multiple points, like during check-in, appointments, and check-out, as well as in appointment reminders. Please ask them to update their address with us and check for our mail a month before their due date.

If you are enrolled as an Application Agent and can assist people with renewals, please be ready to help Medicaid customers connect to coverage. If you are a Federally Qualified Health Center that gets funding for navigators, please assist people who are no longer eligible for Medicaid check with their employer for coverage or sign up on getcoveredillinois.gov.

How do I check my patient's eligibility and renewal date?

You can find their eligibility and renewal date in MEDI or call the patient's Managed Care organization.

To find a patient's renewal date in MEDI:

1. Log in to MEDI at medi.hfs.illinois.gov.
2. After logging in you will arrive at the MEDI Landing page. Choose the link for Internet Electronic Claims System (IEC).
3. When the IEC page opens you will see a left Navigation bar; choose the second option on Left Navigation titled Eligibility Inquiry.
4. From the "Recipient Eligibility Verification" screen you can enter a combination of the listed required fields to search for an individual.
5. All fields DO NOT need to be filled out to search. Use the dropdown to select the prepopulated "Provider ID" and "NPI" fields.
6. Using the begin date entered and the recipient information, the system will search for an individual match. If a match is found the screen will populate with case information including Medicaid eligibility for the date specified, the Recipient Identification Number and the Renewal Due Date(rede). You can also determine the IES Case ID by editing the Case ID listed here by removing the first 5 digits.
   

Will this change the provider enrollment process?

No. The provider enrollment process will stay the same. If you have questions about provider enrollment, please call 877-782-5565 and select option 1.

The truth is nobody knows for sure how many people will lose Medicaid benefits, but we are taking steps to minimize loss as much as possible. A federal analysis estimated about 17% of people will lose Medicaid insurance based on historical patterns. If the federal estimate holds for our state, then around 700,000 will lose Medicaid coverage. Our estimate is more optimistic in that we believe we will be able to help eligible customers keep their benefits. We think about 32,000 people per month will lose Medicaid coverage, or 384,000 after the full unwinding period. 

To be clear: Becoming ineligible for Medicaid coverage doesn't mean you can't get health insurance; it means you need to use other sources of coverage available to you. Most people stop qualifying for Medicaid when they earn too much money. People who no longer qualify for Medicaid should ask their employer about a work-based health plan, or visit getcoveredillinois.gov to shop for quality, affordable coverage provided under the Affordable Care Act. Get Covered Illinois offers free enrollment assistance and can help people find out if they qualify for financial help. Many people find plans for $10 or less per month after tax credits.

We are committed to ensuring that everyone who is eligible maintains their coverage, and that those who are not eligible are given information regarding alternative health insurance options. We strongly urge Medicaid customers to get ready to renew by clicking Manage My Case at abe.illinois.gov to verify their address and find their due date, and then watching their mail so they can complete and submit their renewal materials as soon as they receive them to ensure their coverage continues without disruption. And of course, if someone's situation changes after they are determined ineligible, we encourage them to reapply.

What is HFS doing to engage with Medicaid customers?

We are planning a state-wide, omni-channel, paid, earned, and owned media communications campaign to help our Medicaid customers get ready to renew their Medicaid. The details of this plan will be available soon.

In the meantime, we are asking all Medicaid customers and anyone who works with them to help make sure they are to renew. Please use our messaging toolkit to help in this effort.

Please think about practical ways you can incorporate the renewal messaging and toolkit assets into your interactions with Medicaid customers.

How can I get more information?

You can email hfs.communications@illinois.gov for questions.