I Lost Medicaid—Now What?

As the largest payer for health care in the United States, Medicaid relies on federal funding. Coverage and qualifications vary from state-to-state, and can shift when major funding changes happen at a federal level. 

Losing health insurance can be devastating if you’re living with a chronic illness like diabetes. Here are things to think about that would be interrupted in a coverage gap:

• You may not be able to see your preferred endocrinologist. 
• You may show up at the pharmacy counter to get your insulin, only to find out that it’s no longer covered. 
• Shipments of continuous glucose monitor (CGM) supplies to your home every month might abruptly stop.

If you lose Medicaid coverage, don’t panic. There are options to help you manage your diabetes with minimal interruption.

What is Medicaid?

In a healthcare system built on private insurance, Medicaid is a lifeline for millions. Most of the 90 million people covered by Medicaid are low-income populations, including children, seniors, pregnant individuals and people with disabilities like diabetes.

Medicaid also includes the Children’s Health Insurance Plan (CHIP), which provides no- or low-cost health coverage for children and pregnant people who earn too much to qualify for Medicaid but are not able to afford private health insurance.

Medicaid works like any other insurance plan, except there are no monthly premiums, no yearly deductibles and there are rarely co-payments for medicines like insulin or emergency room visits.

Medicaid is jointly funded and administered in partnership between the federal government and states. So each state’s Medicaid program can be run completely differently from the next, and they also can have different eligibility requirements.

Under the 2010 Patient Protection and Affordable Care Act, 39 states (plus the District of Columbia) have expanded and implemented income eligibility for individuals to qualify for Medicaid, which varies by state and is a percentage of the federal poverty level (FPL). Income eligibility can be determined as often as monthly, so there are a lot of people who typically fall off and back on, especially if their income is variable.

What to do if you’ve lost Medicaid coverage

If you lose Medicaid coverage, don’t panic. There are options to help you manage your diabetes with minimal interruption.

Since losing Medicaid coverage is a “qualifying event,” you qualify for a Special Enrollment Period and do not have to wait for open enrollment to begin on November 1 to find new coverage.

Here are ways to ensure you can get health insurance quickly:

• If you think you’ve been wrongly disenrolled from Medicaid, you can re-apply for your state’s Medicaid program to see if you are still eligible. Find your state’s Medicaid program here.
• Ask your employer if they offer insurance. Sign up ASAP if they do, and coverage will usually begin on the first of the following month).
• Buy your own health insurance on the marketplace.
• If you’re under the age of 26, you may be added as a dependent to your parent’s health insurance plans.
• Additionally, if you’re married and your spouse has health insurance through their employer, you qualify for coverage under their insurance. Check with your spouse’s employer for eligibility requirements (like proof of domestic partnership or marriage, etc.) and costs associated with coverage, which may be higher than if you carried your own insurance.

If you need help affording your insulin, visit getinsulin.org for resources to access insulin quickly, almost always for less than $35 per month.