Medicaid Recertification: An Underestimated and Important Challenge

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Benefit Ninja has found that failure to have in place adequate plans to assist recipients with Medicaid annual recertification's may result in many recipients losing coverage.

At least once a year, Medicaid enrollees must recertify their eligibility for the public health insurance programs. Through the recertification process, changes in income and family size are reviewed as well as any new requirements implemented by the state in the past year. Failure to navigate this process may trigger a disenrollment from the program.

Benefit Ninja ( has found that a common misconception is that once an employee receives Medicaid benefits he or she will remain on Medicaid with no further intervention required. This is absolutely not the case, and recent events in California illustrate both how fundamentally wrong this misconception is, and how failure to have in place adequate plans to assist recipients with Medicaid annual recertification’s may result in many recipients losing coverage.

A recent article from Kaiser Health News explained how changes in the information requested has resulted in failure to return forms and may results in more than a million people losing Medi-Cal (California’s Medicaid Program) coverage:

“Beneficiaries always have to renew their coverage annually, and there is always some churn in enrollment as people’s circumstances change. But this year, the forms asked for a host of new information, and many more people than usual haven’t responded," according to state officials, county welfare directors and advocates.

"In past years, depending on the county, about 20 to 40 percent of Medi-Cal beneficiaries do not renew their coverage. But this year, the numbers are running as high as 50 percent in some counties," according to state Health Care Services Director Toby Douglas. [Source: Kaiser Health News, November 18, 2014,

The Medicaid agencies recognize the challenge of obtaining the necessary information to complete an annual recertification without overwhelming the consumer. "Medicaid annual recertification was always a very involved process", said Rene Mollow, who is the Deputy Director of Healthcare Benefits and Eligibility for the California Department of Healthcare Services. The compressed timeline for development of forms this year contributed to the challenge.

At Benefit Ninja, when we help an individual enroll in Medicaid, we remain the employee’s Authorized Representative. Annual recertification’s can be confusing, time consuming and intimidating. Medicaid recipients, particularly working Medicaid recipients, lead busy lives. They may not have the time necessary to decode complicated requests for information. When the annual recertification occurs, one of our professional Advocates at Benefit Ninja, works with the employee to complete the necessary paperwork and ensure that the application is complete and meet the state requirements.

When recipients fail to recertify for Medicaid there are a host of negative results. The employee faces gaps in healthcare coverage and may be subject to penalties from the IRS (Internal Revenue Services). The lack of medical insurance will force the employee to choose employer-sponsored coverage which leads to significant increase in healthcare costs for the employer.

As states grapple with implementing the Affordable Care Act – particularly those states that have chosen to offer expanded Medicaid coverage – an iterative approach taken by state Medicaid agencies is very likely. This will result in annual tweaks and changes to improve the programs, which may confuse and intimidate Medicaid recipients. A consistent and professional solution for Medicaid recertification is therefore not just an attractive solution but an absolute necessity.

Sean Libby

About Sean Libby. Sean is the president of Benefit Ninja, a national provider of Government Health Benefit Program advocacy services to employers. Sean welcomes the opportunity to discuss the issues from this article with members of the press, employers, and other interested parties.

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Tizjana Mustafaraj
(203) 242-0894

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