Medicaid Unwinding in Vermont: What You Need to Know If You Lose Coverage
Key takeaways:
Medicaid renewals in Vermont are changing because the COVID-19 public health emergency (PHE) ended on May 11, 2023. This is being called the unwinding of Medicaid, and some people will lose coverage during this process.
Medicaid renewals were automatic during the PHE, so 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.
Vermont Medicaid has started reviews to see who is eligible to continue receiving coverage. Make sure the Department of Vermont Health Access has your current contact information. If they can’t reach you, or if you’re no longer eligible for Medicaid, you could lose coverage as early as May 31, 2023.
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 were eligible for Medicaid coverage during the PHE got to keep their health insurance — even if they no longer met eligibility requirements. This is because all states — including Vermont — were required to provide continuous coverage during the PHE.
But the PHE officially ended on May 11, 2023, and automatic Medicaid renewals stopped on March 31, 2023.
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As a result, Vermont has resumed eligibility reviews for Medicaid and Dr. Dynasaur — which covers children under 19 and pregnant women. This is called the redetermination process.
Anyone who no longer qualifies for coverage could be disenrolled as early as May 31, 2023. In fact, the state estimates that about 37,000 people in Vermont could lose their Medicaid coverage over the next year.
Here’s what you need to know about Medicaid changes in Vermont, and what to do if you lose your insurance coverage.
Why is Medicaid changing nationwide?
Now that the PHE has ended, COVID-19 remains a public health priority — just not an emergency. As a result, Medicaid renewals will no longer be automatic.
The process of determining eligibility and enrolling in Medicaid will return to the way it was before the pandemic. This is being referred to as the unwinding of Medicaid.
The unwinding will affect people in all states, Washington, D.C. and five U.S. territories. Over the next year, 5 million to 14 million enrollees nationwide could lose Medicaid coverage.
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What’s happening with Medicaid renewal in Vermont?
The Department of Vermont Health Access (DVHA) is responsible for overseeing and administering the state’s Medicaid program and has released the state’s redetermination plan.
This plan details how Vermont will handle the unwinding as well as how it intends to conduct eligibility reviews for about 200,000 Medicaid and Dr. Dynasaur enrollees.
It’s important for the DVHA to have your current contact information, or you might not receive Medicaid renewal notices. You can confirm or update your information — including adding a cell number for text messages — by:
Logging in to your account on the Vermont Health Connect portal
Calling the Vermont Health Connect customer support center at 855-899-9600
Calling the Green Mountain Care customer support center at 1-800-250-8427 (for long-term care enrollees working with an eligibility specialist)
Vermont’s Medicaid unwinding process will happen gradually over the next year. People who are considered higher risk — such as enrollees with a disability or who have custody of a child — are scheduled for renewal toward the end of this period. The goal is for all eligible Vermonters to keep their Medicaid coverage and for the state to maintain its high insured rate. In 2021, 97% of residents had some form of health insurance.
What to expect during the renewal process
The state’s redetermination process has five steps:
You receive your renewal notice with a due date by mail in a white envelope with a red stripe.
Complete and sign the renewal form.
Mail the completed renewal form to Vermont Health Connect, 280 State Drive, NOB 1 South, Waterbury, VT 05671-8100.
Vermont Health Connect or Green Mountain Care will look at your submission and determine if you are still eligible for Medicaid.
You will get a notice in the mail about the outcome of your renewal.
The DVHA started sending renewal notices to people with Medicaid or Dr. Dynasaur in April. If you’re in the first group, you should have received your notice in April and a reminder in May. This is the process for each renewal group — you will receive a renewal notice one month and a reminder the next that your renewal form is due.
You should receive one of the following types of notices:
Notice of decision: About 40% of Medicaid or Dr. Dynasaur enrollees will get this notice informing them that their benefits can be automatically renewed. If you receive this notice, no further action is required.
Medicaid renewal: About 60% of enrollees will get a notice that they need to verify certain information to determine their eligibility status. If you receive this notice, review and update the information as needed. Be prepared to provide additional information or copies of documents upon request. If you do not respond by the deadline, your benefits can be terminated.
Medicaid closure: If your current benefits are not renewed, or if you do not respond to your renewal on time, you’ll receive this notice.
Tribal health and Medicaid unwinding
Vermont liaisons are reaching out to people who are enrolled in Medicaid and who are also affiliated with or members of Native American tribes.
The National Indian Health Board estimates that as many as 236,000 American Indians and Alaska Natives could lose coverage during the unwinding process. State advocates are working to ensure eligible people in these groups keep their Medicaid coverage.
What should I do if I lose my Medicaid coverage in Vermont?
In order to receive Medicaid in Vermont, you must meet all of the following criteria:
You must be a Vermont resident.
You must be a U.S. citizen, permanent resident, or legal resident.
You need assistance with access to healthcare or insurance coverage.
Your annual household income before taxes must be below the limit for your household size.
In Vermont, you may also qualify for either Medicaid or Dr. Dynasaur for reasons other than income, such as if you are:
Pregnant
A child or teenager
Responsible for the care of a child who is 18 years old or younger
Blind
65 years old or older (and meet certain criteria)
A person with a disability, or you have a person in your household who has a qualifying disability
A former foster child under the age of 26 (and you have aged out of foster care)
In need of nursing home care
Age 19 and older with family planning needs
In need of treatment for breast or cervical cancer (and have been screened or are still undergoing treatment)
If you no longer qualify or the DVHA can’t reach you, you will no longer have access to Medicaid. This could leave you temporarily uninsured.
You can reapply for benefits if you lose your coverage but believe you still qualify. However, you may be uninsured for a while until you’re approved for coverage again.
If you choose not to reapply for Medicaid coverage, or if you’re no longer eligible, you may qualify for other low-cost or free healthcare options. You can also use GoodRx coupons to save on your prescription medications. In addition, you may be able to enroll in an alternative health insurance plan such as:
Affordable Care Act (ACA) marketplace plan: Vermont’s ACA health insurance marketplace is called Vermont Health Connect. You may be able to find an affordable health plan for $10 or less per month if you qualify for a premium subsidy. If you lose Medicaid, you can purchase a plan on Vermont Health Connect during the unwinding special enrollment period from March 31, 2023 to July 31, 2024.
Employer plan: Your company may offer employer-sponsored health insurance.
Medicare: If you have a qualifying disability or condition — such as end-stage renal disease or ALS (amyotrophic lateral sclerosis), commonly referred to as Lou Gehrig’s disease — you can enroll in Medicare at any age.
Partner’s plan: If you have a spouse or domestic partner who has insurance, you may be able to join their plan during an open enrollment or special enrollment period.
Special plans: Short-term insurance can be a great choice if you anticipate a better option, like job-based health insurance, to be available soon. You may also consider alternative and limited-benefit plans, such as fixed indemnity, accident, cost-sharing, and catastrophic insurance.
Student health plan: If you’re enrolled in a college or university, you may be eligible for a campus health plan.
U.S. Department of Veterans Affairs (VA) benefits: If you are an active-duty service member or a veteran, you may qualify for TRICARE coverage or VA benefits and services.
Vermont Medicaid resources
Here are some resources where you can learn more about the upcoming changes to Medicaid in Vermont:
Vermont Medicaid office: Head to the Department of Vermont Health Access site to learn more about the state’s Medicaid program.
Vermont Medicaid self-service portal: Visit Vermont Health Connect to update your contact information or access your account online at any time.
Vermont Medicaid redetermination: Read more about Vermont’s Medicaid unwinding plan and renewal overview, or watch videos on these topics.
Vermont Medicaid unwinding FAQs: Read the answers to frequently asked questions about redetermination and Medicaid renewals.
The bottom line
The COVID-19 public health emergency ended on May 11, 2023, and automatic Medicaid renewals nationwide stopped on March 31, 2023. This is called the unwinding of Medicaid and could result in the loss of healthcare coverage for millions of people.
The Department of Vermont Health Access (DVHA) started Medicaid and Dr. Dynasaur eligibility reviews in April 2023 and expects to continue reviews for a year. If you are determined ineligible, the last day of your Medicaid could be as soon as May 31, 2023. An estimated 37,000 people in the state are expected to lose coverage during the unwinding.
To ensure you receive your renewal notice, update your contact information with DVHA and keep an eye out for a red-striped envelope. If you do lose Medicaid coverage in Vermont, you might still be eligible for other options, such as an Affordable Care Act marketplace plan on Vermont Health Connect, job-based insurance, or Medicare.
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References
Administration for Strategic Preparedness & Response. (2020). Determination that a public health emergency exists.
Administration for Strategic Preparedness & Response. (2023). Renewal of determination that a public health emergency exists.
Agency of Human Services Department of Vermont Health Access. (n.d.). Dr. Dynasaur.
Agency of Human Services Department of Vermont Health Access. (n.d.). Eligibility tables.
Agency of Human Services Department of Vermont Health Access. (n.d.). How the renewal process works.
Agency of Human Services Department of Vermont Health Access. (n.d.). Medicaid.
Agency of Human Services Department of Vermont Health Access. (n.d.). Medicaid renewals restart.
Agency of Human Services Department of Vermont Health Access. (n.d.). Renewal notices.
Agency of Human Services Department of Vermont Health Access. (2023). Unwinding from Medicaid continuous coverage.
Agency of Human Services Department of Vermont Health Access. (n.d.). Vermonters have options when Medicaid renewals restart.
Agency of Human Services Department of Vermont Health Access. (n.d.). Vermont Medicaid programs.
Agency of Human Services Department of Vermont Health Access. (n.d.). What to know.
Agency of Human Services Department of Vermont Health Access. (n.d.). What Vermonters need to know… Medicaid renewal process.
Burns, A., et al. (2023). How many people might lose Medicaid when states unwind continuous enrollment? Kaiser Family Foundation.
Centers for Medicare & Medicaid Services. (n.d.). Medicaid data dashboard.
Centers for Medicare & Medicaid Services. (n.d.). State report on plans for prioritizing and distributing renewals following the end of the Medicaid continuous enrollment provisions.
Centers for Medicare & Medicaid Services. (2023). Temporary special enrollment period (SEP) for consumers losing Medicaid or the Children’s Health Insurance Program (CHIP) coverage due to unwinding of the Medicaid continuous enrollment condition – Frequently asked questions (FAQ).
Fountain, K. (2023). Medicaid reenrollment is underway, and it’s complicated. Vtdigger.
Medicaid.gov. (n.d.). Renew your Medicaid or CHIP coverage.
Medicaid.gov. (n.d.). Unwinding and returning to regular operations after COVID-19.
Tolbert, J., et al. (2023). 10 things to know about the unwinding of the Medicaid continuous enrollment provision. Kaiser Family Foundation.
Tribal Health Reform Resource Center. (2023). Medicaid Unwinding.
U.S. Department of Veterans Affairs. (2022). VA & TRICARE information.
