Lost Medicaid Coverage? Your 5-Step Plan to Stay Protected
If you recently lost Medicaid (or got a letter saying your coverage is ending), you are not alone, and you are not without options. This guide walks you through exactly what to do, step by step, to protect yourself and your family.
Time-Sensitive: Your 60-Day Window
When you lose Medicaid, you get a 60-day Special Enrollment Period to sign up for a Marketplace plan. If you miss this window, you may have to wait until Open Enrollment (November 2026). Act quickly, even if you plan to appeal your termination.
Why Millions Are Losing Medicaid Right Now
If you recently received a notice that your Medicaid is ending, you are part of the largest disruption in health coverage in a generation. Here is what is happening and why.
Post-Pandemic Unwinding (2023 to present)
During COVID, states were required to keep everyone enrolled in Medicaid (the "continuous enrollment" provision). When that ended in 2023, states began redetermining eligibility for all enrollees. More than 25 million people have been disenrolled so far, and many of them were removed due to paperwork problems rather than actually being ineligible.
"One Big Beautiful Bill" Federal Cuts
The 2025 federal budget bill includes roughly $1 trillion in cuts to Medicaid over the next decade. The Congressional Budget Office (CBO) estimates that 11.8 million additional people will lose Medicaid coverage as a result. These changes are being phased in starting in late 2026.
Work Requirements (Starting January 2027)
Beginning January 2027, non-disabled adults ages 19 to 64 must document 80 hours per month of work, volunteering, job training, or community service to keep Medicaid. Exemptions exist for pregnant individuals, caregivers, students, and others (see the FAQ section below). Historical data from Arkansas, where similar requirements were tested in 2018, shows that many eligible people lost coverage simply because they had trouble documenting their hours.
Six-Month Redeterminations (Starting December 2026)
States will be required to redetermine Medicaid eligibility every six months instead of every twelve months. This doubles the paperwork burden and increases the chance that eligible people will lose coverage due to missed deadlines or administrative errors.
Noncitizen Eligibility Restrictions (Starting October 2026)
New restrictions will limit Medicaid eligibility for certain noncitizen populations, including legal permanent residents in their first five years. Previously, some states had chosen to cover these groups using state funds or federal waivers.
The bottom line: losing Medicaid does not mean you did anything wrong. In many cases, it is the result of policy changes, paperwork backlogs, or administrative errors. This guide will help you figure out your next steps regardless of why your coverage ended.
Verify Your Termination Is Correct
Before you do anything else, make sure your Medicaid was actually terminated for a valid reason. A large share of Medicaid terminations during the unwinding have been procedural (paperwork errors, wrong address on file, missed notices) rather than substantive (you actually earned too much or no longer qualify).
Common Errors That Cause Wrongful Termination
- Your state had an outdated address on file and mailed your renewal form to the wrong place
- You returned your paperwork but it was lost, delayed, or not processed in time
- Your state used outdated income data (such as an old tax return) instead of your current income
- You were auto-renewed incorrectly or your electronic renewal failed
- A system glitch or processing backlog caused your case to close
What to Do Right Now
1. Read your termination notice carefully
It should state the specific reason for termination and your appeal rights. If you did not receive a notice, that itself may be a procedural violation.
2. Call your state Medicaid office
Ask them to explain exactly why your coverage was terminated. Update your address and contact information while you are on the phone. You can find your state Medicaid office number at medicaid.gov/contact-us.
3. File an appeal if you believe the termination was wrong
You typically have 90 days from the date on your termination notice to appeal. In many states, if you appeal within 10 to 15 days, your coverage must continue during the appeal process. This is called "aid-paid-pending."
4. Ask about retroactive reinstatement
If your termination was a procedural error, many states can reinstate your coverage retroactively to cover any medical bills you incurred during the gap.
Key point: Even if you are filing an appeal, still complete the remaining steps in this guide. Apply for Marketplace coverage within your 60-day window as a backup. If your Medicaid is reinstated, you can cancel the Marketplace plan.
Check If You Qualify for Other Coverage
Losing Medicaid unlocks a Special Enrollment Period (SEP) that gives you 60 days to sign up for other health coverage. Here are your options, starting with the most common.
ACA Marketplace Plans (Healthcare.gov)
Best option for most people losing Medicaid
- Losing Medicaid triggers a 60-day Special Enrollment Period
- Premium tax credits can make plans cost $0 to $50/month depending on income
- Cost-sharing reductions (Silver plans) lower deductibles and copays for people under 250% FPL
- Apply at Healthcare.gov or call 1-800-318-2596 (24/7, available in 150+ languages)
CHIP (Children's Health Insurance Program)
For children in families with income too high for Medicaid
CHIP covers children up to age 19 in families earning up to 200% to 300% of the Federal Poverty Level (varies by state). Income limits for children are significantly higher than for adults, so even if you no longer qualify for Medicaid, your children may still be eligible for CHIP.
Apply at Healthcare.gov or call 1-877-KIDS-NOW (1-877-543-7669).
Employer-Sponsored Coverage
If you or a family member has access through work
Losing Medicaid also qualifies you for a special enrollment window with your employer's plan. Check with your HR department. Even if you previously declined employer coverage because you had Medicaid, you can enroll now. Employer plans may be more expensive than subsidized Marketplace plans, so compare both before choosing.
Medicare
If you are 65+ or have a qualifying disability
If you are 65 or older, or if you have been receiving Social Security Disability for 24 months, you may qualify for Medicare. Some people ("dual-eligibles") had both Medicare and Medicaid. If you lose Medicaid but still have Medicare, your Medicare coverage continues. Contact Social Security at 1-800-772-1213 or your local SHIP office for help.
State Basic Health Programs
Currently available in Minnesota and New York
Minnesota (MinnesotaCare) and New York (Essential Plan) offer state-run coverage for people earning up to 200% of the Federal Poverty Level. These plans often have lower premiums and cost-sharing than Marketplace plans. If you live in one of these states, check with your state exchange.
Know Your Hospital Financial Assistance Rights
Even if you have no insurance at all, you have more protections than you might think. If you need medical care before your new coverage kicks in (or if you remain uninsured), here is what you need to know.
Your Legal Rights at Nonprofit Hospitals
Every nonprofit hospital in the United States (roughly 60% of all hospitals) is required by federal law (IRS Section 501(r)) to:
- Have a written financial assistance policy (also called "charity care")
- Make that policy available to patients in plain language
- Not charge uninsured patients more than insured patients for the same care
- Not use "extraordinary collection actions" (wage garnishment, liens, credit reporting) until they have made reasonable efforts to determine if you qualify for financial assistance
Who Qualifies?
Eligibility varies by hospital, but most nonprofit hospitals offer:
- Free care for patients earning below 200% of the Federal Poverty Level ($31,200/year for an individual, $64,400 for a family of four in 2026)
- Discounted care (50% to 80% off) for patients earning up to 300% to 400% FPL
- You can apply before or after receiving care (most hospitals allow applications up to 240 days after discharge)
How to Apply
1. Ask for the financial assistance application
Call the hospital billing department or visit their website. They are legally required to provide this to you.
2. Gather your documents
You will typically need proof of income (pay stubs, tax return, or a signed statement), proof of household size, and a copy of your Medicaid termination notice.
3. Submit your application
Most hospitals accept applications by mail, fax, or in person. Some now accept online applications. Keep copies of everything you submit.
4. Follow up in 2 weeks
If you have not heard back, call and ask for a status update. Do not let a bill go to collections while your application is pending.
CareRoute maintains a searchable database of hospital financial assistance policies, including eligibility thresholds and application links. You can look up any hospital to see what they offer.
Search hospital financial assistance policiesCommunity Health Centers: An Immediate Safety Net
Federally Qualified Health Centers (FQHCs) are required to see everyone, regardless of insurance status or ability to pay. They charge on a sliding fee scale based on your income. There are nearly 1,400 community health center organizations operating over 15,000 sites across the country.
Find one near you: findahealthcenter.hrsa.gov or call 1-800-275-4772.
Protect Yourself from Medical Bills
If you need medical care while uninsured (or while waiting for new coverage to start), you are not helpless. There are concrete steps you can take to reduce or eliminate medical costs.
Ask for Cash-Pay or Self-Pay Rates
Hospitals and providers often offer significant discounts (40% to 60% off the list price) for patients who pay out of pocket. Always ask before treatment. The "chargemaster" (list) price is a starting point for negotiation, not the final price. Many hospitals are legally required to charge uninsured patients no more than what insurance companies pay.
Request an Itemized Bill and Check for Errors
Up to 80% of medical bills contain errors. Always request a fully itemized bill showing every charge, CPT code, and quantity. Common errors include duplicate charges, incorrect codes, charges for services not received, and "unbundling" (billing separately for items that should be billed together).
Negotiate Before and After Treatment
For planned procedures, get price estimates in advance and compare costs between facilities. After treatment, do not accept the first bill. Ask for hardship discounts, prompt-pay discounts (typically 10% to 25% off for paying within 30 days), or an interest-free payment plan.
Know Your State's Medical Debt Protections
Many states have laws that protect patients from aggressive medical debt collection, limit interest on medical debt, require hospitals to screen for financial assistance before sending bills to collections, or cap the amount uninsured patients can be charged. These protections vary by state.
If you receive a medical bill you cannot afford, CareRoute's Bill Defense tool can help you identify billing errors, find financial assistance programs you qualify for, and negotiate with providers.
Learn about Bill DefenseGet Free Help Navigating the System
You do not have to figure this out alone. Multiple organizations offer free, confidential help to people who have lost health coverage.
SHIP Counselors
State Health Insurance Assistance Programs provide free, unbiased counseling to help you understand your coverage options, compare plans, and enroll. Available in every state.
shiphelp.org |1-877-839-2675
Healthcare.gov Navigators
Trained navigators and certified application counselors can help you apply for Marketplace coverage, premium tax credits, and Medicaid/CHIP for free. They are available by phone, online, and in person.
localhelp.healthcare.gov |1-800-318-2596
Community Health Centers
HRSA-funded health centers provide primary care, dental, mental health, and pharmacy services on a sliding fee scale. Many also have enrollment assisters who can help you apply for coverage.
findahealthcenter.hrsa.gov |1-800-275-4772
Legal Aid Organizations
If your Medicaid was wrongfully terminated, legal aid can help you appeal for free. They also help with medical debt, billing disputes, and insurance denials.
211 Helpline
Dial 2-1-1 from any phone to connect with local resources including food banks, utility assistance, housing help, and healthcare services. Available 24/7 in most areas.
211.org |Dial 2-1-1
Area Agencies on Aging
For seniors and their caregivers, Area Agencies on Aging provide free help with Medicare, Medicaid, prescription assistance, and community services.
eldercare.acl.gov |1-800-677-1116
State-by-State Resources
Your rights and options vary significantly by state. Many states have additional protections for uninsured patients, expanded Medicaid eligibility, or state-specific programs. Check your state's medical bill rights page for detailed information.
Frequently Asked Questions
Can I appeal my Medicaid termination?
How long is my Special Enrollment Period after losing Medicaid?
What if I am pregnant and lose Medicaid?
What about my children if I lose Medicaid?
What if I cannot afford Marketplace premiums?
What about my prescriptions if I lose Medicaid?
Can hospitals turn me away if I have no insurance?
What are the Medicaid work requirement exemptions?
You Have More Options Than You Think
Losing Medicaid is stressful, but it does not mean you are on your own. Between Marketplace subsidies, hospital financial assistance, community health centers, and free counseling programs, there are real paths to affordable care. Take it one step at a time.