Medicaid renewal: how redetermination works

Last verified: June 2026

Medicaid renewal — formally called redetermination — is the process your state uses to verify you still meet Medicaid eligibility requirements. Federal rules require states to complete a renewal for every enrollee at least once every 12 months. If you do nothing and your state cannot confirm your eligibility through its own data sources, your coverage can be terminated.

The renewal process got significant attention between 2023 and 2024, when states began disenrolling people for the first time after a three-year pandemic freeze. Over 25 million people lost coverage during that period, per KFF tracking data — a number that revealed how many enrollees had outdated contact information or simply never received a renewal notice.

Knowing how the process works — and what triggers a termination — is the most practical thing you can do to protect your coverage.

What annual redetermination requires

Every 12 months, your state must verify that you still qualify for Medicaid. The requirement comes from 42 CFR Part 435, which sets minimum federal standards for how and when states conduct renewals. States cannot skip a year or push renewals past 12 months without a specific federal waiver.

The redetermination looks at the same factors used in the original application: income relative to the Federal Poverty Level (FPL), household size, residency, and citizenship or immigration status. For most adults and children covered under the ACA Medicaid expansion, income is measured using MAGI (Modified Adjusted Gross Income) rules, per CMS guidance. Older adults and people with disabilities generally use different methodologies based on SSI income rules.

Coverage ends at the close of the month in which you no longer meet requirements — not immediately on the date the state makes a determination. That one-month buffer gives enrollees a short window to appeal or correct an error.

Ex parte renewal: when the state renews you automatically

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.

The 2023–2024 unwinding: what happened and why it matters

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 those 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.

• Disenrollment rates ranged from 57% in Montana to 12% in North Carolina (per KFF, 2024)
• North Carolina's low rate correlated with its 90%+ ex parte renewal rate — most renewals completed without enrollee action
• Florida and Louisiana processed hundreds of thousands of disenrollments during the unwinding period
• States that relied heavily on paper mail had far higher procedural disenrollment rates
• As of February 2026, 74.9 million people remain enrolled in Medicaid/CHIP nationally — down 21% from the 2023 peak, per KFF

How to complete a Medicaid renewal when you receive a form

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. In some states it's a short one-page form. Others ask for documentation: recent pay stubs, a tax return, or a letter from an employer. The renewal notice will specify what, if anything, you need to submit.

What happens if you miss the renewal deadline

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. The termination notice 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.

Keeping your contact information current

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.

Renewal timelines for specific populations

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. Some states have extended that postpartum period to 12 months under a CMS-approved option. NC Medicaid, for example, extended postpartum coverage to 12 months in 2023 under a state plan amendment. Florida Medicaid extended postpartum coverage to 12 months in 2022 following federal authorization.

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.

How Medicaid renewal differs from Medicare renewal

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.

Medicaid cuts and coverage reductions: separate from renewal

Periodic federal and state budget debates raise the possibility of changes to Medicaid eligibility rules or income thresholds — sometimes referred to as "Medicaid cuts." These are different from the renewal process. Renewal is an administrative process to verify whether you currently meet existing rules. A change in the rules themselves — through legislation or a federal waiver — is a policy change that operates on a different track.

If Congress were to lower the income threshold from 138% FPL to a lower figure, or if a state received a waiver to add work requirements, those changes would be announced with a public notice period and effective date. You would not simply find your coverage gone one month — states are required to notify affected enrollees in advance of policy-based coverage changes.

Watch your mail and email from your state Medicaid agency regardless — especially in periods of active federal budget discussions.

What to do if your coverage was wrongly terminated

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 — don't miss it. In most states, filing an appeal before your coverage ends allows you to continue receiving coverage while the appeal is pending (called "aid paid pending"), though you may owe premiums 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. A list of federally funded legal aid offices is available through lawhelp.org.