Redetermination: The fight to keep our community members enrolled in Medicaid

Paula Derrow

Community & consumer engagement Strengthening ecosystems of care COVID response Policy & advocacy Public benefits SDOH & health equity

One of our Community Ambassadors puts a flyer with information about NJ Medicaid redetermination into a neighbor's mailbox

In March of 2020, as the COVID pandemic took hold, Congress declared a public health emergency and passed the Families First Coronavirus Response Act. As a result of this legislation, people on Medicaid were able to stay continuously enrolled in the program throughout the pandemic, without having to renew their coverage annually (as is required in the state of NJ).

The new act made a dramatic difference in helping people across the country get the healthcare they needed. The Kaiser Family Foundation (KFF) estimates that to date, Medicaid and CHIP enrollment have grown by 23.3 million people, most low-income adults and children. That’s a 28.5 percent increase compared with numbers in February of 2020.

Now, millions stand to lose these benefits. As of April 1, 2023, and continuing for a period of 12 months, people receiving Medicaid will be responsible for reenrolling in the program — the technical term is redetermination — meaning that anyone on Medicaid will need to prove they are still eligible for coverage, including verifying their contact information, income, employment status, services they’ve utilized, and all the documentation that involves.

According to the KFF, between 5 million and 14 million people could lose coverage in the coming year, including 6.8 million who are still eligible. The reasons for that loss could be as simple as not receiving notice of the need to reenroll in the mail, because a recipient has changed addresses, as so many people did during the pandemic.

The risk of being bumped off Medicaid is even greater for vulnerable populations with complex health and social needs, such as those served by the Camden Coalition. These individuals have more trouble accessing traditional services in the best of circumstances. “We’re talking about unhoused individuals, the elderly, people with substance abuse disorders or children living in poverty,” says Maritza Gomez, Program Manager for Community Engagement and Capacity Building for the Camden Coalition. “It’s urgent that we get the word out to this population and let people know that this is happening right now.”

Fortunately, the Camden Coalition learned some important lessons during the pandemic about how to work with local partners and community members to effectively get information to people who need it most. “Because of COVID, we already have that organizational infrastructure to build on,” says Victor Murray, Senior Director of Community Engagement and Capacity Building for the Camden Coalition.

Leveraging lessons learned in COVID

In January 2020, the Camden Coalition was designated a Regional Health Hub (RHH), one of four organizations to act as a bridge between the state’s Medicaid office and New Jersey community residents and organizations. During the pandemic, this designation enabled the Camden Coalition to convene state and local partners to ensure Camden residents had access to services, COVID testing, and, eventually, vaccines.

Right now, one of the state’s top priorities is Medicaid recertification. To that end, says Shelby Kehoe, Program Manager for Policy and Advocacy at the Camden Coalition, “We will coordinate with other Regional Health Hubs in Trenton, Passaic and Newark, taking what we’ve learned in Camden, sharing our knowledge with our health hub partners, and also learning from them in real time.”

In addition to working with other RHHs in the state, the Camden Coalition is leveraging their existing ties within the community as well as identifying and collaborating with other vital partners, from state agencies to local health systems. These partners will likely include the NJ Department of Human Services; New Jersey Citizen Action, a statewide nonprofit that has been working closely with New Jersey Medicaid; Cooper University Health Care; and the Camden County Board of Social Services, among others.

The Camden Coalition’s Community Ambassadors program, launched in 2021 to do community outreach regarding COVID testing and vaccines, will be utilized to get the word out about the need to reenroll in Medicaid. “Similar to how we trained and activated our Ambassadors during the pandemic, sending them door-to-door to work through misinformation, we will train our Ambassadors on the details of Medicaid redetermination so they can talk to neighbors about the need to do things like update their contact information with their healthcare providers and state agencies,” says Victor.

Tables are being set up at shelters and emergency food providers like Cathedral Kitchen to inform people as they come by for meals that they need to reenroll in Medicaid. Outreach efforts will also focus on Camden County’s senior centers and schools, as well as local healthcare providers. “It’s not the role of a doctor or a nurse to enroll patients in Medicaid, but we want to make sure that healthcare providers know this is happening, so they can catch their patients before they fall through the cracks,” says Shelby, adding:

“Too often in these situations, the parties involved tend to be siloed. We’re using what we did during COVID as a model to bring everyone together.”

Not sure what to do if you’re on Medicaid in NJ? Follow these guidelines:

  • Call NJ FamilyCare/Medicaid at 1-800-701-0710 (TTY: 711) to confirm or update your contact information, especially if you’ve moved in the last three years. 
  • Watch your mail for a renewal packet. 
  • Reply promptly to avoid a gap in coverage. 
  • If you believe your eligibility was incorrectly terminated, you have appeal rights. These rights are explained in the packet you receive. If you do not have the letter or you have questions, you can call NJ FamilyCare at 1- 800-701-0710 (TTY: 711).
  • If you’ve lost eligibility because you did not provide all the information that was needed, you can provide that information within 90 days to have your renewal application reconsidered.
  • If you are ineligible for NJ FamilyCare due to your income level, you can apply for coverage through GetCoveredNJ.
  • Go to this website for more information about how to stay covered and what to do if you lose coverage.