Understanding the “Unwinding” of the Public Health Emergency and its Effect on Medicaid Benefits and Services -

By: Shelley Grostefon

In March of 2020, special protections guaranteed Continuous Coverage for anyone receiving Medicaid benefits. This means that if you were receiving Medicaid in March of 2020 or if you began receiving Medicaid benefits anytime after, these benefits could not be reduced or eliminated, even if your income or resources increased. The only exceptions are if you voluntarily stopped coverage or if you moved out of state.

In 2023, these protections are being phased out as part of the “unwinding” of the public health emergency. If you received Medicaid in March of 2020 or began receiving benefits since, you will be required to go through the renewal process. Below, we detail the essential information for those affected by the unwinding to ensure that their coverage continues if they are eligible, as well as resources for those who need more information or assistance.

What do I need to do to renew my coverage?

Coverage can only be reduced or terminated based on a review of a completed renewal. So, until you go through the renewal process, your coverage will not change.

Renewals will be sent in batches over 12 months, beginning in March and April 2023. If your Medicaid benefits will be reduced or terminated based on the information you provide, that change will not occur before July 1.

When you receive the renewal request, you need to fill it out and send it back. You will receive a paper copy in the mail. If you live in New York City, you can file your renewal online; otherwise, the only way to fill out and return the renewal is via the paper copy you receive.

What if…?

…My income has increased enough so that I will no longer be eligible for Medicaid. You can begin a “spend down,” which will allow you to lower your income so that you still qualify for Medicaid. To see if your income falls above income and asset limits, see the Department of Health’s guidelines. You can contribute to a pooled trust to ensure you meet Medicaid eligibility guidelines. If you live in Western New York, you can contribute to a trust through the Western New York Coalition Pooled Trusts or call (866) 362-5081 for more information.

…I have a spend down. The protections banned states from increasing a recipient’s spend down. Now that the protections are being unwound, be aware that your spend down may increase. Fortunately, the income and asset limits increased as well.  To see where you fall, see the Department of Health’s guidelines.

…I think my spend down will decrease or become $0. You don’t have to wait to receive a renewal notice in the mail. Instead, you can contact your local Department of Social Services and request rebudgeting now. If your spend down is causing issues paying for necessities, this could reduce hardship. If you contributed to a pooled trust, this could reduce required payments.

…I did not receive a renewal packet and I don’t receive income via Social Security. Hang tight—these will be sent out over the course of a year. To predict when you will receive your notice,

… If you think you should have already received your notice, you can contact your local Department of Social Services.

…I receive income via Social Security. You will not receive a renewal package, and your coverage will be automatically renewed with no action needed.

…I moved since I last renewed or began coverage. If you live in New York City, contact the Human Resources Administration. If you live outside of New York City, contact your local Department of Social Services to ensure your address is updated so that you receive your renewals.

…I want to renew online. If you live in New York City, you can renew online through the Human Resources Administration. If you live outside of New York City, you can only renew via the paper copy you receive in the mail.

…I don’t currently have Medicaid but I intend to apply. You will still be affected by the unwinding. During the public health emergency, verification requirements for Medicaid applications were eased and rules for signatures were loosened. However, these protections will end on July 1, 2023. Be sure that you are aware of the requirements in effect when you apply. You will apply through your local Department of Social Services.

…I receive Medicaid and enrolled in Medicare after March 2020. You are Dual Eligible, and it is likely that your Medicaid case will remain on New York State of Health, unless your income is above the Medicaid limit—then it will be transferred to the local Medicaid office.

…I receive Medicaid, I enrolled in Medicare after March 2020, and I receive Medicaid personal care, CDPAP, private duty nursing, or adult day care from my Medicaid managed care plan. You will now be required to enroll in a managed long term care plan, and your Medicaid will be transferred to the local Medicaid office.

…I receive Medicaid, I enrolled in Medicare after March 2020, and I do not receive home care or other long term services. When you are up for renewal, you will be disenrolled from your Medicaid managed care plan. You will now have “regular” or “Fee for Service” Medicaid as secondary insurance to your Medicare. The only exceptions are if you were enrolled in Medicare by default into a Medicare Dual Special Needs Plan operated by the same insurance plan that operates your Medicaid managed care plan.

Will I lose my coverage if I forget to send in my renewal? Is there any lenience?

If you do not send in your renewal in a timely manner, you may be eligible for a waiver, but only in certain circumstances:

If you currently receive Medicaid benefits and your resources are above the resources limits (which are: $30,182 for singles and $40,821 for couples), you will have a one-year waiver. This means that for renewals occurring before May 2024, benefits will not be discontinued if your assets are over the asset limit.

If you receive SNAP benefits, your Medicaid benefits will be automatically renewed for a year. Furthermore, by the end of 2023, all future renewals for those receiving SNAP benefits will be processed automatically. Please note that if your renewals are handled by New York State of Health, you are not eligible for the SNAP waiver.

If you do not send in the first renewal form sent to your address on file and you do not receive SNAP benefits, you will receive a second form. If you do not complete and return the second form, your benefits will be eliminated.

Furthermore, if you appeal a decrease or elimination of your benefits and the appeal is denied, you may request a Fair Hearing. If you request a Fair Hearing within 120 days after the notice of a threatened reduction or discontinuance of Medicaid eligibility or services, you would receive “Aid Continuing.” “Aid Continuing” means that the threatened reduction or discontinuance cannot take effect until your Fair Hearing takes place. This is an extension of the previous time limit.

What if I have questions?

For general questions about Medicaid, see our Frequently Asked Questions and Fact Sheet.

The Center for Elder Law & Justice is available to help. New Yorkers can call us at (716) 853-3087 or use the form at the bottom of this page. In addition, our free legal advice helpline can provide answers to brief legal questions to residents of New York State who are 55 or older. Call at 1-844-481-0973 between 9am and 11am to reach an attorney directly or call and leave a message. The helpline can also be contacted via e-mail at helpline@elderjusiceny.org.

Please note, information in this post is subject to change at any time. This blog post is intended as general information only, and should not be considered legal advice. You should consult with an attorney about your specific circumstances.