Medicaid Unwinding in the U.S. Virgin Islands: What You Need to Know If You Lose Coverage
Key takeaways:
Medicaid renewals in the U.S. Virgin Islands (USVI) 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.
USVI Medicaid has restarted eligibility reviews for enrollees. So if you’re covered under Medicaid, make sure the agency has your current contact information. If you can’t be reached or are no longer eligible, 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 the U.S. Virgin Islands (USVI) — were required 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.
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Medicaid programs operate differently in the five U.S. territories with permanent populations:
U.S. Virgin Islands
In all of the territories, except for American Samoa, Medicaid eligibility primarily depends on the incomes of individuals or households.
Here’s what you need to know about Medicaid changes in the USVI, and what to do if you lose your insurance coverage.
Why is Medicaid changing nationwide?
Now that the PHE has come to an end, COVID remains a public health priority — just not an emergency. As part of this process, Medicaid renewals are no longer 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.
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What’s happening with Medicaid renewal in the USVI?
The U.S. Virgin Islands Department of Human Services (VIDHS) has resumed eligibility reviews for the more than 35,000 people who are enrolled in Medicaid and the Children’s Health Insurance Program (CHIP) in the territory. This is called the redetermination process.
For the first group of Medicaid enrollees who failed to renew or no longer qualified, coverage ended on July 1, 2023.
The VIDHS is asking Medicaid enrollees to update or confirm their contact information through the agency’s self-service citizen portal or by contacting their local VIDHS office. This includes current mailing address, phone number, and email. If you are covered by USVI Medicaid, you may have received a text message reminder that included a link to an “update my contact information” form.
If you need to reach out to the VIDHS directly, the agency has three contact numbers:
Headquarters in St. John: 340-776-6334
St. Thomas office: 340-774-0930
St. Croix office: 340-718-2980
If you are enrolled in Medicaid, your renewal form should arrive in the mail about 45 days before your coverage is set to end. Send the completed form with the required documents to the VIDHS via:
Mail
Email
Drop box outside your local VIDHS office
How does Medicaid work in the USVI?
The Centers for Medicare & Medicaid Services (CMS) funds Medicaid in the USVI based on the percentage of people who potentially qualify. During the COVID PHE, Medicaid funding was increased in the USVI. The territory’s pandemic-era 83% federal match was permanently extended in a budget bill signed in December 2022 by President Joe Biden.
The USVI 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.
What should I do if I lose my Medicaid coverage in the USVI?
In order to receive Medicaid in the USVI, you must meet all of the following criteria:
You must be an U.S. Virgin Islands resident.
You must be a U.S. citizen, permanent resident, or legal resident.
You must need assistance with access to healthcare or insurance coverage.
Your annual household income before taxes are withheld must be below the limit for your household size.
In the U.S. Virgin Islands, you may also qualify for reasons other than income, including if you are:
Pregnant
A child or teenager
Responsible for the care of a child who is 18 or younger
Blind or have another disability
A household member of someone who has a qualifying disability
Age 65 or older (and meet certain criteria)
A former foster child who is 25 or younger
Age 19 or older and have 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 VIDHS can’t reach you, you will not be able to use your Medicaid benefits. If you lose your coverage but believe you still qualify, you can appeal the decision or reapply for Medicaid. 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:
Employer plan: If you have a job, 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 that a better option, like job-based health insurance, will be available soon. You may also consider alternative and limited-benefit plans, such as fixed indemnity, accident, cost-sharing, and catastrophic insurance plans.
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.
The bottom line
Automatic Medicaid renewals stopped on March 31, 2023 in advance of the COVID-19 public health emergency (PHE) ending on May 11.
In the U.S. Virgin Islands, the Department of Human Services (VIDHS) has resumed eligibility reviews for more than 35,000 people who are enrolled in Medicaid and the Children’s Health Insurance Program (CHIP). On July 1, 2023, the first group of people who no longer qualified for Medicaid or did not respond to renewal information requests from USVI Medicaid lost their coverage.
USVI Medicaid enrollees are being asked to update or confirm their contact information through the VIDHS’ self-service citizen portal or by contacting their local VIDHS office.
If you lose your USVI Medicaid coverage, you can reapply or appeal the decision by requesting a fair hearing. You may also qualify for other health insurance options, like an employer plan or Medicare. USVI residents do not qualify for Affordable Care Act (ACA) coverage.
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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.
Hofschneider, A. (2022). Federal budget bill permanently increases Medicaid funding for US Pacific territories. Honolulu Civil Beat.
Medicaid.gov. (n.d.). Medicaid & CHIP in United States Virgin Islands.
Medicaid.gov. (n.d.). Renew your Medicaid or CHIP coverage.
Medicaid.gov. (n.d.). Unwinding and returning to regular operations after COVID-19.
National Association of Medicaid Directors. (2019). Territory operations survey.
Office of the Governor American Samoan Government. (2023). Governor Lemanu P.S. Mauga testimony.
Tolbert, J., et al. (2023). 10 things to know about the unwinding of the Medicaid continuous enrollment provision. Kaiser Family Foundation.
U.S. Department of Veterans Affairs. (2022). VA & TRICARE information.
U.S. House of Representatives Congresswoman Stacey E. Plaskett. (2022). Medicaid cliffs no more, Congresswoman Plaskett recounts journey to monumental Medicaid win for the Virgin Islands.
U.S. Virgin Islands Department of Human Services. (n.d.). DHS Universal Access.
U.S. Virgin Islands Department of Human Services. (2023). Medicaid renewals are happening now!
U.S. Virgin Islands Department of Human Services. (2023). USVI Medicaid program [video]. YouTube.
U.S. Virgin Islands Department of Human Services. (2023). VIDS announces "updated my contact information" for all Medicaid members.
