Medicaid Renewal: How Redetermination Works

Before sending you a renewal form, states are required by federal rules to first try to verify your eligibility using data they already have. This is called an ex parte renewal — Latin for "on one side," meaning the state completes the process without requiring action from you.

States check sources like state wage databases, tax records, and Social Security Administration data. If the data confirms you still qualify, your coverage renews automatically. You may receive a notice saying your coverage was renewed, but you do not need to fill out a form. Only if the ex parte check is inconclusive or turns up a potential problem does the state send you a renewal packet.

Ex parte renewal rates vary sharply by state, per KFF's 2024 unwinding tracker. Arizona, North Carolina, and Rhode Island renewed 90% or more of eligible enrollees automatically. Pennsylvania and Texas renewed fewer than 20% automatically — meaning most of their enrollees had to return paperwork to stay covered. That gap reflects differences in how well states have integrated data systems, not differences in how many people were actually still eligible.

During the COVID-19 pandemic, Congress required states to keep all Medicaid enrollees continuously enrolled — no disenrollments — as a condition of receiving enhanced federal matching funds. That provision ran from March 2020 through March 31, 2023. By the time it ended, national Medicaid and CHIP enrollment had reached a record 94 million enrollees, per KFF.

The most troubling finding: 69% of disenrollments were for procedural reasons — missed paperwork, outdated addresses, forms not returned in time — not because the person was determined ineligible. Many may still have qualified but simply didn't respond, often because they never received the notice in the first place.

If the ex parte check doesn't resolve your case, your state will send a renewal form — typically by mail, and increasingly by email if you've provided one. Federal rules require the state to give you at least 30 days to respond. The form asks you to confirm or update your household income, household size, and address; some states ask for supporting documentation such as pay stubs or a tax return.

If you don't return the form by the deadline, the state terminates your coverage at the end of that month. You should receive a termination notice, which is separate from the renewal notice — it must include information about your right to appeal.

Federal rules — specifically 42 CFR 431.206 through 431.246 — require states to provide a fair hearing process. If you believe the termination was wrong, you can request a hearing within the timeframe listed on the notice, usually 30 to 90 days depending on the state.

If coverage was terminated and you were still eligible, you can also reapply. In some cases, coverage can be reinstated retroactively — that's worth asking about explicitly when you contact the state agency.

The single most effective thing you can do to avoid a wrongful termination is keep your mailing address — and email address, if your state supports it — current in the system. The unwinding data made this plain: millions of renewal notices went to outdated addresses and were never received.

Most states allow you to update your contact information through an online account portal, by phone, or in person. You don't need to wait for a renewal to update your address. If you've moved in the past year, update it now.

Most Medicaid enrollees renew annually. A few populations have different rules. Children enrolled through Medicaid or CHIP who are under 19 must be renewed at least once a year, but states may not disenroll a child during a 12-month enrollment period for income changes that occur mid-year — that protection does not apply to adults covered under the expansion.

Pregnant women present a special case. Medicaid coverage for a pregnant woman typically extends through 60 days postpartum regardless of income changes during the pregnancy, and — as of 2026 — all 50 states and DC have adopted the option to extend that postpartum coverage period to a full 12 months, per KFF's postpartum coverage tracker.

Seniors and people with disabilities may face a more involved renewal if their state uses non-MAGI methodologies — asset verification, for instance, requires more documentation than income-only cases.

Medicaid and Medicare are separate programs with different renewal mechanics. Medicare — the federal program primarily for adults 65 and older — does not require an annual eligibility renewal in the same way. Once enrolled in Medicare Part A, you stay enrolled without annual redetermination unless your circumstances change dramatically.

Medicaid requires annual redetermination regardless of how long you've been enrolled. Even if your income hasn't changed in five years, the state must confirm eligibility each year. That rule applies nationally.

For people enrolled in both programs — often called dual eligibles — the Medicaid renewal process still applies. Dual eligibility status is reassessed as part of the standard Medicaid redetermination.

A 2025 federal budget reconciliation law (sometimes called the "One Big Beautiful Bill Act") made the most significant change to Medicaid eligibility rules in the program's history: a federal work requirement. This is not a state waiver or a hypothetical — it is enacted law that applies in the 43 expansion states plus DC no later than January 1, 2027, and states cannot opt out of it through a Section 1115 waiver.

Most ACA expansion adults ages 19–64 must document at least 80 hours per month of work, school, job training, or qualifying community engagement, unless they qualify for an exemption (parents of young children, people with disabilities, pregnant women, and several other groups are exempt). States must verify compliance at initial application, at every renewal, and — this is the key change to redetermination — must redetermine eligibility for this population at least twice a year rather than once, once the requirement takes effect.

This is different from a routine annual renewal: it adds a documentation burden specific to expansion adults, and missing a compliance check can result in disenrollment even if your income hasn't changed. States are required to give advance notice before the requirement takes effect and before any resulting termination.

Start by requesting a formal fair hearing from your state agency — every state must have a fair hearing process, per CMS. The deadline to request a hearing is printed on your termination notice. In most states, filing an appeal before your coverage ends allows you to continue receiving coverage while the appeal is pending ("aid paid pending"), though you may owe premiums back if the state wins.

If you believe the termination was a data error — the state had the wrong income on file, for instance — gather documentation that corrects the record and bring it to the hearing or submit it in advance.

Legal aid organizations in your state can help if the hearing process is confusing. Many states have Medicaid-specific legal aid programs.