Medicaid Unwinding in Wisconsin: What You Need to Know If You Lose Coverage
Key takeaways:
Medicaid renewals in Wisconsin 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.
The Wisconsin Department of Health Services (DHS) has started Medicaid eligibility reviews to determine who qualifies to continue receiving coverage. Make sure the DHS has your current contact information. If they can’t reach you, or if you’re no longer eligible for Medicaid, your last day of coverage could be as early as May 31, 2023.
If you lose Medicaid coverage during the unwinding, you may qualify for a low-cost alternative health insurance option, such as an Affordable Care Act marketplace plan.
The U.S. Department of Health and Human Services declared a public health emergency (PHE) for COVID-19 in January 2020. From January 2020 to February 2023, the PHE was renewed a dozen times.
People who were eligible for Medicaid coverage during PHE got to keep their health insurance even if they no longer met the eligibility requirements. This is because all the states — including Wisconsin — were required to provide continuous coverage during the PHE.
But the COVID-19 PHE officially ended on May 11, 2023, and automatic Medicaid renewals stopped on March 31. Over the next year, 5 million to 14 million enrollees nationwide could lose Medicaid coverage.
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Wisconsin has resumed eligibility reviews for the more than 1.6 million people enrolled in the state’s Medicaid programs. This is called the redetermination process. If you no longer qualify, your last day of coverage could be as early as May 31, 2023. In fact, the state estimates that about 300,000 people in Wisconsin could lose their Medicaid coverage over the next year.
Here’s what you need to know about Medicaid changes in Wisconsin, 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 could affect millions of people in all states, Washington, D.C. and five U.S. territories.
What’s happening with Medicaid renewal in Wisconsin?
The Wisconsin Department of Health Services (DHS) is responsible for overseeing the state’s Medicaid programs. These include Medicaid programs for children, such as BadgerCare Plus. DHS has an unwinding operational plan that outlines how the state intends to conduct eligibility reviews for current enrollees. This means you will now be required to renew your coverage annually by providing information about household details such as income, assets, and insurance.
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The restarting of renewals affects Wisconsin residents enrolled in the following Medicaid programs:
BadgerCare Plus
Emergency Services Medicaid
Family Planning Only Services
Foster Care Medicaid
Institutional Medicaid
Katie Beckett Medicaid
Medicaid Purchase Plan
SeniorCare
Supplemental Security Income Medicaid
Supplemental Security Income-Related Medicaid
Tuberculosis-Related Medicaid
Waiver Medicaid
Wisconsin Well Woman Medicaid
It’s important that you confirm or update your address, mobile phone number, and email with DHS so that you receive important alerts and updates. You can confirm or update your information by:
Logging into your account on the ACCESS self-service portal
Logging into the MyACCESS app
Calling the member services helpline at 1-800-362-3002 from 8 AM to 6 PM (CT) Monday through Friday
What to expect during the renewal process
The DHS has started reviewing Medicaid eligibility. All enrollees should have received a letter mailed in March that indicates their assigned renewal date. Renewal dates are staggered from June 2023 to May 2024. If you would like to see an electronic copy of this letter, log into your ACCESS account.
It’s important to wait to take action on your renewal until you’re prompted to do so by DHS. Your renewal packet should arrive in the mail about two weeks before your renewal month. There will also be a digital version in your ACCESS account.
You can complete your renewal in the following ways ways:
Online: The quickest way to renew is through your ACCESS account.
Mail: You can complete and return your renewal packet by mail.
Phone: You can call 1-800-362-3002.
In person: You can visit a local DHS location near you.
Once your renewal packet is received and reviewed, you will receive information about whether your coverage will be continued or terminated.
If you lose coverage because you miss the renewal deadline, you may have 90 days from the date your Medicaid ended to submit your renewal. If approved, your insurance will be retroactively reinstated with no gap in coverage.
Tribal health and Medicaid unwinding
Wisconsin liaisons reach out to ensure eligible people who are also affiliated with or members of Native American tribes are enrolled in Medicaid.
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 Wisconsin?
In order to receive Medicaid in Wisconsin, you must meet all of the following criteria:
You must be a Wisconsin 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 must be below the limit for your household size.
In Wisconsin, you may also qualify for reasons other than and in addition to income, including 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
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 DHS can’t reach you, you will no longer be able to use your benefits, which could leave you temporarily uninsured.
Alternatives to Medicaid in Wisconsin
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: On the ACA health insurance marketplace, 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 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 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.
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.
Wisconsin Medicaid resources
Here are some resources where you can learn more about Medicaid in Wisconsin and upcoming changes related to the end of the public health emergency:
Wisconsin Medicaid office: The Wisconsin Department of Health Services (DHS) oversees and administers the state’s Medicaid program.
Wisconsin Medicaid self-service portal: You can confirm or update your contact information by visiting the ACCESS self-service portal, which you can use to reach your online account 24/7.
Wisconsin Medicaid redetermination: Read more about Wisconsin’s Medicaid unwinding plan and renewal fact sheet.
Wisconsin Medicaid renewal FAQs: Find answers to frequently asked questions.
Wisconsin Medicaid office phone assistance: You can call DHS at 1-800-362-3002.
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, 2023.
The Wisconsin Department of Health Services (DHS) will spend a year reviewing the eligibility of more than 1.6 million Medicaid enrollees through mid-2024. Make sure the state has up-to-date contact information for you to ensure you receive mail and electronic notifications. A notice about your assigned renewal month should have been mailed to you and should appear in your ACCESS account. About two weeks before your renewal month, your renewal packet should arrive in the mail and a digital version should appear in your ACCESS account.
If you lose Medicaid because you are no longer eligible, you may still qualify for other health coverage, such as an Affordable Care Act marketplace plan, job-based insurance, or Medicare.
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References
Benefits.gov. (n.d.). Wisconsin Medicaid.
Centers for Medicare & Medicaid Services. (2023). 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. National Indian Health Board.
U.S. Administration for Strategic Response and Preparedness. (2020). Determination that a public health emergency exists.
U.S. Administration for Strategic Response and Preparedness. (2023). Renewal of determination that a public health emergency exists.
U.S. Department of Veterans Affairs. (2022). VA & TRICARE information.
Van Egeren, J. (2023). With pandemic emergency ending, 300,000 Wisconsin residents could lose Medicaid coverage. Milwaukee Journal Sentinel.
Wisconsin Department of Health Services. (2023). Income maintenance and tribal agency contact information.
Wisconsin Department of Health Services. (2023). Keeping Wisconsin covered.
Wisconsin Department of Health Services. (2023). Medicaid - enrollment renewal fact sheet.
Wisconsin Department of Health Services. (2023). Medicaid in Wisconsin.
Wisconsin Department of Health Services. (2023). Medicaid news for members: Post-COVID changes.
Wisconsin Department of Health Services. (2023). Medicaid programs for children.
Wisconsin Department of Health Services. (2023). Operational plan: COVID-19 public health emergency (PHE) unwinding and return to routine operations.
