Key takeaways:
Medicaid renewals in Guam are changing because of the end of the COVID-19 public health emergency (PHE) on May 11, 2023. This is being called the unwinding of Medicaid, and some people will lose coverage during this process.
During the PHE, Medicaid renewals were automatic, and enrollees had continuous coverage. As part of the unwinding process, automatic renewals for Medicaid and the Children’s Health Insurance Program (CHIP) stopped nationwide on March 31, 2023.
Guam Medicaid started reviews in May 2023 to determine who is eligible to continue receiving coverage. Make sure you confirm or update your contact information with the Department of Public Health and Social Services. If they can’t reach you, or if you’re no longer eligible for Medicaid, you could lose coverage.
The U.S. Department of Health and Human Services declared a public health emergency (PHE) for COVID-19 in January 2020. The PHE was renewed a dozen times through February 2023.
People who qualified for Medicaid during the COVID PHE were able to keep their coverage throughout the pandemic without having their eligibility reviewed. This is because all 50 states, Washington, D.C., and five territories — including Guam — were mandated to provide continuous coverage during the PHE.
But the PHE ended on May 11, 2023. And that marked the end of most COVID provisions, like automatic Medicaid renewals, which stopped nationwide in March. These changes could cause 8 million to 24 million Medicaid enrollees across the country to lose coverage.
Medicaid programs operate differently in the five U.S. territories with permanent populations:
Guam
U.S. Virgin Islands
Other than American Samoa, Medicaid eligibility depends on the incomes of individuals or households in all of these territories.
Here’s what you need to know about Medicaid changes in Guam, and what to do if you lose your insurance coverage.
Why is Medicaid changing nationwide?
After the PHE ends, COVID-19 will remain a public health priority — just not an emergency. As part of this process, Medicaid renewals will no longer be automatic. This is being referred to as the unwinding of Medicaid.
The unwinding will affect Medicaid in every state, Washington, D.C., and five U.S. territories.
What’s happening with Medicaid renewal in Guam?
Guam Medicaid is overseen by the Bureau of Economic Security , a division of the Department of Public Health and Social Services (DPHSS). The territory plans to review eligibility for about 48,000 enrollees. This is known as redetermination.
DPHSS is asking enrollees to send an updated contact information form with your current mailing address, phone number, and email — even if your information hasn’t changed — to expedite the redetermination process.
You can confirm or update your household’s contact information with DPHSS by submitting the completed updated contact information form:
By email to mapclientupdate@dphss.guam.gov
In person at a drop-off center in Dededo, Inarajan, Mangilao, or Tamuning
Guam’s 12-month redetermination process began in May 2023. Enrollees with the highest use of Medicaid will be reviewed toward the end of the unwinding period, which will be the summer of 2024. Once your case is decided, you will receive a Notice of Action. The letter will say your coverage will continue, more information is needed, or that you no longer qualify for Medicaid.
How does Medicaid work in Guam?
The Centers for Medicare & Medicaid Services funds Medicaid in Guam based on the percentage of people who potentially qualify. During the COVID PHE, Medicaid funding was increased in Guam. The territory’s pandemic-era 83% federal match was permanently extended in a budget bill signed in December 2022 by President Joe Biden.
Guam received extra funds for its Medicaid program instead of establishing an Affordable Care Act (ACA) marketplace. That means residents can’t enroll in ACA coverage. Individuals and families assigned to U.S. Naval Base Guam are enrolled in TRICARE and receive medical services at Naval Hospital Guam.
What should I do if I lose my Medicaid coverage in Guam?
If you are no longer eligible for Medicaid, you will receive a termination of coverage letter. If you have the option to enroll in an employer’s health plan, you should do so within the 30 days of your Medicaid termination date. Losing coverage due to the unwinding qualifies you for a special enrollment period. You should attach the termination of coverage letter to your employer’s group health plan enrollment form.
If you believe you lost coverage but still qualify, you can appeal by requesting a fair hearing within 90 days of your termination letter’s date by:
Visiting the Bureau of Management Support-Unit #15, 130 University Drive, Mangilao, Guam, 96913
Calling 671-735-7344 or 671-735-7256
The bottom line
Automatic Medicaid renewals stopped on March 31, 2023 in advance of the COVID-19 public health emergency’s conclusion on May 11.
Guam’s Department of Public Health and Social Services (DPHSS) began reviewing the eligibility of about 48,000 enrollees in May 2023. DPHSS is asking enrollees to complete and submit an updated contact information form — even if your information hasn’t changed. This will ensure you can be reached when it’s your turn to renew.
Enrollees who have a high use of Medicaid services will be reviewed closer to the end of the redetermination period, which is set to end the summer of 2024.
Guam residents do not qualify for Affordable Care Act coverage. If you lose Medicaid, you may be able to join a job-based group plan. You can also appeal the decision by requesting a fair hearing.
Why trust our experts?
References
Administration for Strategic Response and Preparedness. (2020). Determination that a public health emergency exists.
Administration for Strategic Response and Preparedness. (2023). Renewal of determination that a public health emergency exists.
Centers for Medicare & Medicaid Services. (2023). Unwinding and returning to regular operations after COVID-19.
Department of Public Health and Social Services. (n.d.). General frequently asked questions.
Department of Public Health and Social Services. (n.d.). Stay covered and be informed: Prepare for Medicaid eligibility unwinding.
Hofschneider, A. (2022). Federal budget bill permanently increases Medicaid funding for US Pacific territories. Honolulu Civil Beat.
Medicaid.gov. (n.d.). Medicaid & CHIP in Guam.
National Association of Medical Directors. (2019). Territory operations survey.
Office of the Governor American Samoa Government. (2023). Governor Lemanu P.S. Mauga testimony, United States Senate Committee on Energy and Natural Resources.
San Nicolas, J. (2023). DPHSS to begin federally mandated Medicaid unwinding. Department of Public Health and Social Services.
Tolbert, J., et al. (2023). 10 things to know about the unwinding of the Medicaid continuous enrollment provision. Kaiser Family Foundation.
