In March 2020, the federal government declared a COVID-19 public health emergency (PHE). The PHE allowed states to provide continuous Medicaid coverage for most people enrolled in Medicaid for more than two years. As of March 31, 2023, however, continuous Medicaid eligibility for some adults and children ended and you may have to re-establish eligibility. Starting on April 1, 2023, Texas Medicaid resumed Medicaid and Children’s Health Insurance Program (CHIP) eligibility reviews or redeterminations. As a result, some people with Medicaid or CHIP have been disenrolled from these programs.
Below are some things you can do to prepare, some options if you no longer qualify for Medicaid or CHIP, and some organizations that may be able to help you.
Make sure Texas Medicaid has your current mailing address, phone number, email, or other contact information. This way, they will be able to contact you about your Medicaid or CHIP coverage. You can review and update all of your personal information with Texas Medicaid by calling 2-1-1 or logging into YourTexasBenefits.com account.
Texas Medicaid will be mailing you a letter about your Medicaid or CHIP coverage. These “renewal notices” will be mailed in a yellow envelope that says “Action Required” in red or will be sent electronically to those beneficiaries who signed up for electronic notices. You will need to complete and return the renewal packet or request for information on time. You must be given a minimum of 30 days to respond to renewal packets or requests for information.
If you believe Texas Medicaid’s decision that you no longer qualify for Medicaid or CHIP is wrong, you can request a Medicaid Fair Hearing to contest this decision. You should get a written notice explaining why Texas Medicaid claims you no longer qualify. While you have 90 days from the date of the denial notice to request a Fair Hearing, if you request the Fair Hearing within 10 days of the date of the denial notice, your Medicaid or CHIP coverage will continue until a hearing is held and the hearings officer issues the decision. This continuation of benefits pending the hearing decision is an important protection against the immediate loss of Medicaid eligibility.
If Texas Medicaid correctly determines that you no longer qualify for Medicaid or CHIP or you lose your fair hearing, there are options you can consider.
You may be able to buy a health plan through the Health Insurance Marketplace. Losing Medicaid or CHIP coverage is a Qualifying Life Event (QLE), which allows you to enroll in a Marketplace plan outside of the Open Enrollment Period. Visit HealthCare.gov or call the Marketplace Call Center at 1-800-318-2596 (TTY: 1-855-889-4325) to get details about Marketplace coverage. Four out of five former Medicaid beneficiaries can find plans that cost less than $10 per month. To apply, you will need current information about your household, income, and Texas Medicaid’s decision about your Medicaid or CHIP coverage.
You may be able to sign up for Medicare without paying a late enrollment fee. If you now qualify for Medicare, but did not sign up for it when you first became eligible, you have a limited time (the “Special Enrollment Period”) to sign up without paying the usual penalty. Your Special Enrollment Period starts the day Texas Medicaid notifies you that your Medicaid coverage is ending and continues for 6 months after your Medicaid coverage ends. To sign up for Medicare during this Special Enrollment Period, fill out a CMS-10797 Form and mail or fax it to your local Social Security Office. You can also call Social Security at 1-800-772-1213. TTY users can call 1-800-325-0778.
You may be able to obtain health care coverage through the CHIP program or the Medicaid Buy-In for Children (MBIC) program.
To apply for CHIP, visit YourTexasBenefits.com to access the application, or you can apply by phone by calling 2-1-1, picking a language, and then pressing 2. A Texas Health and Human Services Commission (HHSC) representative will then help you with your application over the phone and mail it to you to sign.
For more information about the Medicaid Buy-In for Children program, and to apply, visit the Medicaid Buy-In for Children webpage.
Disability Rights Texas (DRTx) is a state-wide nonprofit protection and advocacy organization that advocates and litigates on behalf of persons with disabilities. To find out if DRTx can help you, go to intake.drtx.org or call 1-800-252-9108. You can send specific questions regarding Medicaid unwinding or Medicaid eligibility issues to MedicaidIssues@DRTx.org.
Founded in 1970 to represent Texas farmworkers, Texas Rio Grande Legal Aid (TRLA) has grown into the nation’s second-largest legal aid provider and the largest in Texas. TRLA provides free civil legal services to residents in 68 counties in South and West Texas and represents migrant and seasonal farm workers throughout the state and in six other southern states. To find out if TRLA can help you, call (956) 996-8752 or (833) 329-8752 M-F, 9 a.m. to 5 p.m. CST.
TRLA has offices in Alpine, Austin, Beeville, Brownsville, Corpus Christi, Del Rio, Eagle Pass, Edinburg, El Paso, Floresville, Harlingen, Laredo, Mercedes, Nashville (TN), Rio Grande City, San Antonio, Sinton, Uvalde, Victoria, and Weslaco.
Legal Aid of NorthWest Texas (LANWT) is a nonprofit organization that provides free civil legal help to low-income residents in 114 Texas Counties throughout North and West Texas, with offices in Abilene, Amarillo, Brownwood, Dallas, Denton, Ft. Worth, Lubbock, McKinney, Midland, Odessa, Plainview, San Angelo, Waxahachie, Weatherford, and Wichita Falls. To find out if LANWT can help you, go to the LANWT Get Help webpage.
Lone Star Legal Aid’s (LSLA) mission is to protect and advance the civil legal rights of low-income Texans by providing advocacy, legal representation, and community education that ensure equal access to justice. Headquartered in Houston, we operate 14 offices, covering one-third of the state and 72 counties in East Texas and along the Texas Gulf Coast. We provide legal assistance to eligible applicants in civil matters, including matters related to all public benefit programs such as SNAP and Medicaid. To apply for LSLA services call toll-free (800) 733-8394 or apply online on LSLA’s website.
TLSC helps income-eligible Texans from any part of the state access free legal services that support healthcare, safety, stability, housing, government benefits, and employment. Our staff who may be able to assist you on questions related to the Covid-19 Public Health Emergency and continuous Medicaid coverage ending can be contacted as follows:
You may also wish to complete an online services application at TLSC.org or access free legal information about the legal questions you have, including chatting with an attorney, at our website TexasLawHelp.org.
Publication Code: HC22
www.DRTx.org
Statewide Intake: 1-800-252-9108
Sign Language Video Phone: 1-866-362-2851
Purple 2 Video Phone: 512-271-9391
Online Intake available 24/7: intake.DRTx.org
Disclaimer: Disability Rights Texas strives to update its materials on an annual basis, and this handout is based upon the law at the time it was written. The law changes frequently and is subject to various interpretations by different courts. Future changes in the law may make some information in this handout inaccurate.
The handout is not intended to and does not replace an attorney’s advice or assistance based on your particular situation.
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