If You Don't Meet the Work Requirement

The steps, in order

1. The state checks its data. It must look at payroll, program, and medical claims records for every month being checked before deciding it cannot confirm you.
2. You get a notice of noncompliance. It must say which months are being checked, how to show you met the rule or are exempt, the deadline, how to send information (online, phone, mail, or in person), and what happens if you don't respond.
3. You have 30 calendar days. The 30 days start when you receive the notice. Unless you show otherwise, you are treated as receiving it 5 days after the date printed on it. If you are enrolled, your coverage continues during this time. Some states give longer: Missouri gives 35 calendar days, and Wisconsin gives 35 days from the mailing date. Arizona gives 35 days to answer a request for information before any noncompliance notice.
4. The state looks for other coverage. Before ending your Medicaid, it must check whether you qualify for Medicaid another way, or for another program.
5. Advance written notice and hearing rights. If you still don't qualify, you get written notice before coverage ends, with your right to a fair hearing.
6. Coverage ends no later than the end of the month after the month your 30 days ran out. For example, if your 30 days end March 20, coverage could end by April 30.

How to respond to a notice

• Read which months are listed. You only need to show the months the notice names.
• Send proof of hours, income, school, or an exemption the way the notice says. Online portals are usually fastest. Keep a copy and write down the date.
• If you don't have papers, explain why and give what you can. States cannot deny you only because papers that don't exist are missing.
• Call the number on the notice if you need more time or help. Legal aid offices and navigators can also help for free.

Appealing: the fair hearing

You have the right to a state fair hearing if your application is denied or your coverage is ending. Your notice will say how and by when to ask. If you ask for a hearing before the date your coverage is set to end, federal Medicaid rules generally keep your benefits going until the hearing decision. At the hearing you can explain your situation, bring proof, and bring someone to help you.

Good reasons to appeal include: you were exempt but the state missed it, your hours or income were counted wrong, you never got the notice, or the state didn't check other ways you could qualify.

Reapplying

There is no waiting period. The CMS rule bars states from limiting when you can reapply after losing coverage for this reason. When you reapply, you'll need to show you met the rule in the month or months before you apply (1 to 3, depending on your state). If you were cut off for not returning information and you send it within your state's reconsideration period (90 days under federal renewal rules), the state must reconsider without a new application.

The marketplace subsidy bar

If you lose Medicaid, or are denied, because you did not meet the requirement, the law treats you as still eligible for Medicaid for tax credit purposes. That means you cannot get premium tax credits to lower the cost of a HealthCare.gov or state marketplace plan for those months. You can still buy a plan at full price, and states such as Illinois and New Jersey point people to their marketplaces for that.