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Losing Medicaid & Finding Affordable Health Coverage

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Across the country, and especially in states like Texas, Virginia, New Jersey, Maryland, and Kentucky, a major shift is underway. After a period of continuous enrollment, states are once again reviewing the eligibility of millions of residents for Medicaid. This process, often called "Medicaid unwinding" or "redetermination," means that many individuals and families who once relied on Medicaid may find that they no longer qualify.

 

This can be a confusing and overwhelming time, leaving many wondering where to turn for health insurance. The good news is that the Affordable Care Act (ACA), often referred to as Obamacare, provides a powerful safety net. For those who lose their Medicaid coverage, the ACA offers a clear and affordable path to private health insurance, with substantial financial assistance available to make it a viable option.

 

At EIMA Health Insurance, we're here to help you navigate this critical transition. We understand the specific challenges facing residents in major cities like Houston, Dallas, San Antonio (Texas), Virginia Beach, Richmond, Northern Virginia (Virginia), Newark, Jersey City, Paterson (New Jersey), Baltimore, Silver Spring, Columbia (Maryland), and Louisville, Lexington, Bowling Green (Kentucky). Our goal is to walk you through every step of the process, from understanding why you may have lost coverage to finding and enrolling in a new plan that fits your needs and budget.

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The Medicaid Unwinding: What's Happening in Your State

The end of the federal Public Health Emergency meant that states could begin the process of redetermining Medicaid eligibility for all enrollees. This has led to millions of people losing coverage, primarily for two reasons: they were found to be no longer eligible based on income or other factors, or they lost coverage for “procedural reasons,” such as not completing a renewal form or providing the necessary documents on time.

  • Texas: As a non-expansion state, Texas has some of the strictest Medicaid eligibility rules in the country for adults. As of late 2024, Texas’s disenrollment rates have been high, with many individuals losing coverage for procedural reasons. The state’s focus has been on redetermining eligibility for people they expected to no longer qualify, such as those who have aged out of children’s categories or who were covered due to pregnancy.
  • Virginia: As a Medicaid expansion state, Virginia’s Medicaid program provides a broader safety net. However, the unwinding process is still impacting thousands of residents. As of mid-2024, procedural denials for renewals accounted for a large portion of disenrollments, highlighting the importance of updating contact information and submitting renewal forms on time.
  • New Jersey: New Jersey has a robust Medicaid program (NJ FamilyCare) and an active state-based marketplace (Get Covered New Jersey) to help with transitions. The state has been actively working to ensure a smooth transition, but procedural disenrollments remain a challenge.
  • Maryland: Maryland has a very low uninsured rate, thanks in part to its Medicaid expansion and state-based marketplace (Maryland Health Connection). However, even with these resources, many residents are losing coverage during the redetermination process. The state has an innovative “Easy Enrollment Health Program” that can help people who lose coverage by using their tax returns to identify those who may qualify for a new plan.
  • Kentucky: As a Medicaid expansion state that operates its own state-based marketplace (kynect), Kentucky has strong systems in place to help residents. However, as of mid-2025, over a million Kentuckians are still enrolled in Medicaid, and the ongoing redetermination process will continue to impact thousands of residents.
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ACA & Affordable Healthcare FAQs

Q1: What is the Affordable Care Act (ACA), and what are its key benefits for me? A1: The Affordable Care Act (ACA), also known as “Obamacare,” is a federal law designed to make health insurance more accessible and affordable. Its key benefits include:

  • No Pre-Existing Condition Denials: Insurers cannot deny you coverage or charge you more because of a pre-existing health condition.
  • Financial Assistance (Subsidies): If your income is above your state’s Medicaid limit but below a certain threshold (400% FPL), you can get a tax credit (subsidy) to lower your monthly premium.
  • Essential Health Benefits: All plans sold through the ACA Marketplace must cover 10 essential health benefits, including doctor visits, hospitalization, prescription drugs, mental health, and maternity care.

 

Q2: How much financial help can I get with an ACA plan? A2: The amount of financial help you receive depends on your household income and family size. For those transitioning off of Medicaid, the subsidies are often very generous. In most states, if your income is between 100% and 400% of the Federal Poverty Level, you’ll qualify for a premium tax credit that significantly lowers your monthly premium. Many people find they can get a high-quality plan for less than $100 a month, or in some cases, for free.

 

Q3: What are Cost-Sharing Reductions (CSRs)? A3: Cost-Sharing Reductions (CSRs) are a special type of financial assistance that lowers the amount you have to pay out-of-pocket for healthcare services, such as your deductibles, copayments, and coinsurance. CSRs are only available if you enroll in a Silver-level plan on the ACA Marketplace and meet specific income requirements. If you qualify, we highly recommend a Silver plan, as it can offer the best value.

 

Q4: What if I miss my Special Enrollment Period after losing Medicaid? A4: If you miss your 60-day SEP, you may have to wait until the next Open Enrollment Period to sign up for a plan. Open Enrollment for 2026 plans typically runs from November 1, 2025, to January 15, 2026. However, some states may have special rules or extensions. It’s crucial to contact us immediately to explore all your options.

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EIMA Health Insurance: Your Partner in the Medicaid Transition

The Medicaid redetermination process doesn’t have to be a source of stress. The transition to an ACA plan is a well-established and affordable pathway to continued coverage.

At EIMA Health Insurance, we offer a personalized, step-by-step approach:

Step

Your Action

How EIMA Helps

1. Notification

You receive a notice from your state Medicaid office.

We review your notice to confirm your eligibility for a Special Enrollment Period and explain your options.

2. Information Gathering

You gather your household income and family information.

We help you organize the necessary documents and ensure you have all the information needed for a smooth application.

3. Plan Search

You’re overwhelmed by plan choices on the marketplace.

We use our expertise to compare plans from all major carriers, focusing on what’s available in your specific city or metro area.

4. Application & Enrollment

You’re ready to apply but find the process confusing.

We guide you through the online application for your state’s marketplace (e.g., HealthCare.gov, kynect, Get Covered New Jersey) and help you select the best plan.

5. Ongoing Support

You have questions about your new plan or benefits.

We are your resource for the entire year, available to answer questions and provide support.

 

 

Don’t go through this transition alone. Contact EIMA Health Insurance today for a complimentary consultation. We are here to empower you with the knowledge and support you need to secure your health and financial future.

Step-by-Step: Moving from Medicaid to an ACA Plan

If you've received a notice that your Medicaid coverage is ending, don't panic. You have options, and EIMA Health Insurance is here to help. Losing your Medicaid coverage is considered a Qualifying Life Event (QLE), which triggers a Special Enrollment Period (SEP). This allows you to enroll in a new health plan through the ACA marketplace outside of the standard Open Enrollment Period.

Here's a simple guide to your transition:

  1. Check Your Mail: Pay close attention to any mail or emails from your state's Medicaid office. This is where you'll receive your redetermination notice. This notice will explain if your coverage is ending and when.
  2. Act Quickly: You typically have 60 days from the date you lose your Medicaid coverage to enroll in a new plan through the ACA marketplace.
  3. Gather Your Information: You'll need key details to apply for an ACA plan, including:
    • Social Security numbers or immigration documents for everyone in your household.
    • Information about your household income.
    • Your notice from the state Medicaid agency that confirms your coverage is ending.
  4. Connect with EIMA Health Insurance: This is the most crucial step. We will walk you through the process, helping you to:
    • Confirm your eligibility for an ACA Special Enrollment Period.
    • Compare plans from various carriers, including plan types, networks, and benefits.
    • Determine how much financial assistance you qualify for.
    • Complete the application and enroll in your new plan.

Medicaid FAQs for Residents of TX, VA, NJ, MD, KY

Q1: What is the main reason I might lose my Medicaid coverage during the redetermination process? A1: The two most common reasons are:

  • Ineligibility: Your income has increased, or your household size has changed, and you no longer meet the state’s eligibility requirements.
  • Procedural Disenrollment: Your state’s Medicaid office couldn’t reach you because your contact information was out of date, or you did not complete and return your renewal forms and necessary documents on time.

 

Q2: What are the income limits for Medicaid in my state? A2: Medicaid eligibility varies significantly by state and by household type (e.g., adult, child, pregnant person).

  • Texas: Texas has not expanded Medicaid, so income limits are very low for parents and caregivers (e.g., about 12% FPL). Adults without children are not eligible regardless of income.
  • Virginia, New Jersey, Maryland, and Kentucky: These states have all expanded Medicaid, so adults can qualify with an income up to 138% of the Federal Poverty Level (FPL).
    • For a single adult in 2025, 138% FPL is approximately $2,036/month or $24,436/year. For a family of three, it’s approximately $3,456/month or $41,478/year.
    • Resource: Visit your state’s Medicaid website for the most up-to-date and specific income limits.

 

Q3: My income is still low, but my state says I no longer qualify for Medicaid. Why? A3: This is a common situation during the unwinding. It could be for a few reasons:

  • Your income, while still low, may be slightly above your state’s specific Medicaid threshold.
  • If you’re in Texas, the state’s low income limits for adults mean even a very small income can disqualify you.
  • You may have been a victim of a procedural disenrollment and didn’t complete the necessary paperwork on time.

 

Q4: I have a disability. Does that change my Medicaid eligibility? A4: Yes. In all of these states, eligibility for individuals who are aged, blind, or have a disability is often determined under a different set of rules, which may include asset limits in addition to income. If you have a disability and lose your Medicaid, it’s crucial to apply for an ACA plan and mention your disability during the application process, as there may be additional programs or assistance available.

Useful Local Resources for Residents:

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