Worried about losing Medicaid access in Wisconsin? Here’s what to know

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Wisconsin's June 2023 restart of annual eligibility checks for Medicaid following a three-year pause has eliminated coverage for more than 360,000 residents, as WPR and Wisconsin Watch reported this month. Some of those disenrolled had struggled to fill out recertification paperwork, and others have faced difficulties in finding alternative insurance plans.

Many who lose Medicaid coverage have turned to the federal Health Insurance Marketplace, where low-income households can qualify for subsidies.

But an increasing number of households are enrolling in plans they don't need and can't afford, advocates say.

Here's what to know about renewing Medicaid coverage, finding alternative plans if need be and avoiding insurance scams.

What is Medicaid? Medicaid provides health insurance to low-income households. In Wisconsin that includes programs like BadgerCare Plus, which serves children, pregnant people and non-disabled adults. It also pays for long-term care programs for people with disabilities and seniors.

Why have so many people lost coverage in the past year? The federal government requires states each year to verify Medicaid recipients' eligibility, but it paused the mandate early in the pandemic to help people maintain coverage. Verification resumed a year ago in Wisconsin — a process called unwinding.

About 30% of those up for renewal over the past year were disenrolled.

I lost Medicaid. What should I do next?Some people face disenrollment despite still qualifying for Medicaid. So before looking for new coverage, first check on whether you still qualify for Medicaid, said Adam VanSpankeren, navigator program manager for Covering Wisconsin, a University of Wisconsin-Madison Division of Extension program that helps people enroll in publicly funded health care.

While about 37% of people booted from Medicaid during unwinding no longer met income or health requirements, most lost coverage due to procedural issues such as missing or incorrectly filled out paperwork. So getting a disenrollment letter in the mail doesn't necessarily mean you're ineligible.

That's especially true for children who qualify for Medicaid under a much higher income threshold than adults.

And if you confirm you no longer qualify for Medicaid? Explore other coverage options as soon as possible, VanSpankeren said.

Employees have a limited window to immediately enroll in job-based coverage after losing benefits. Otherwise, they need to wait for their employer's next open enrollment period to begin.

Timelines for enrolling in a marketplace plan are more flexible. But if you're interested in those options, you should still act quickly to avoid a gap in your health coverage, VanSpankeren said.

Who can help me navigate coverage options?Get in touch with Covering Wisconsin by calling 608-261-1455 or 414-400-9489 or by using this online tool to book an appointment.

Its health care navigators can help:

Check the status of your Medicaid renewal.Help determine whether you still qualify for Medicaid benefits.Explore other coverage options, including on the federal marketplace.Offer assistance in several languages.

You can separately call 211 to get connected with local resources.

Should I be aware of anything else when searching for a replacement plan?Insurance scams are spiking in Wisconsin, VanSpankeren said, "in a way that is concerning navigators like never before."

With Medicaid unwinding causing confusion nationwide, fraudulent insurance brokers are increasingly trying to enroll people in private insurance plans they don't need, qualify for or even know about.

Here are VanSpankeren's tips for avoiding insurance scams:

If you're talking on the phone with a broker, ask where the broker is located. If the person on the other line avoids answering or mentions another state, hang up and find someone else to work with.Look for website URLs that end with .gov, like Healthcare.gov, when researching online.If someone calls you, search for the person's information online. Trustworthy health care navigators should have easily identifiable contact information, including a phone number consumers can call back.

If you suspect you've enrolled in scam insurance, call Covering Wisconsin or 211 and file a complaint with the Wisconsin Office of the Commissioner of Insurance, VanSpankeren recommends.

Addie Costello is WPR's Mike Simonson Memorial Investigative Reporting Fellow embedded in the newsroom of Wisconsin Watch.