What Are Medicaid Renewals?

Medicaid Renewals are the annual process states use to determine if Medicaid recipients still meet their financial eligibility requirements – the asset limit and the income limit – as well as their medical eligibility criteria. If they no longer meet any of those requirements, or if they fail to complete their Renewal Form, they will lose their coverage.

The Renewal process also ensures that Medicaid beneficiaries have received, and will continue to receive, all of their benefits. If the care needs of the individual have changed, its possible benefits can be increased, or reduced, during the Renewal process. If the state reduces benefits that are actually needed, beneficiaries can appeal the decision through formal and informal channels, which is another process covered by our Renewal Subscription Service.

Medicaid Renewal can also be called Medicaid Redetermination or Recertification. No matter the name, it applies to all three types of Medicaid long-term care relevant to seniors – Nursing Home Medicaid, Home and Community Based Services (HCBS) Waivers and Aged, Blind and Disabled (ABD) Medicaid.

Medicaid Renewal Process

Medicaid Renewal for seniors and individuals with disabilities must occur at least every 12 months, regardless of where they reside. It is possible for individuals to go through more than one redetermination in a 12-month period.

The exact process can vary depending on the state and the Medicaid program in which one is enrolled, but, in general, state Medicaid officials will examine a beneficiary’s financial situation to determine if they still meet the asset and income limit. This means the Medicaid agency will review bank accounts, income sources, tax returns, pension statements, the equity value of one’s home and any other relevant financial holdings.

Step 1: If possible, the state will examine financial holdings electronically. This is known as automatic or ex parte renewal and requires little or no action from the beneficiary.

Step 2: If the beneficiary’s financial holdings cannot be completely checked electronically, they will receive a letter and/or email with a Medicaid Renewal Form that must be completed, dated, signed and returned within 30 days to guarantee uninterrupted coverage. In some states, the Renewal Form may be pre-populated with information state officials found while they were doing the electronic check. Most Medicaid recipients will have to complete their Medicaid Renewal Form and provide proof of income and assets.

Gathering all of the financial documents required as proof of assets and income (bank statements, tax returns, Social Security benefits letters, etc.) is usually a time-consuming task. It can be difficult for seniors and their families to identify which documents they need, collect them from various financial institutions, and complete the Medicaid Renewal Form all within the 30-day window. This is another benefit of our Renewal Subscription service – our team of professionals will know exactly what financial documents are needed and where to get them, they have vast experience completing Medicaid Renewal forms, and they will handle both tasks for subscribers.

Step 3: If the beneficiary’s health condition has changed, the state may also conduct a care needs reassessment during the Renewal Process in order to determine the full extent of the change. Using the information from the reassessment, the state will decide if the individual’s benefits should be increased, or decreased, to more accurately match the beneficiary’s needs.

When the care needs of a Medicaid Renewal Service subscriber change, our team of professionals at Eldercare Resource Planning will be proactive in providing the state with proof of the change so the subscriber receives the care they need and deserve. If the state decreases benefits that a subscriber needs, our team will handle the appeal process. This includes informal communication with the appropriate state officials to ask for an increase of benefits, formal appeals for a fair hearing to challenge the decrease in benefits, and full support and representation before, during and after the hearing.

For Married Beneficiaries

When only one spouse in a married couple applies for Medicaid, the assets of both spouses are counted toward the asset limit of the applicant spouse. However, when a married Medicaid beneficiary undergoes their annual Renewal, the assets of the community spouse (also known as the healthy spouse) are not counted toward the asset limit of the beneficiary spouse. So, a community spouse can accrue assets without impacting the Medicaid eligibility of the beneficiary spouse. This often comes into play if the community spouse sells the couple’s home, moves into a smaller residence and makes a profit on the home sale.

It should be noted that the community spouse is allowed to keep up to $162,660 in 2026 (depending on the state and the couple’s financial situation) of the couple’s assets during the application process, thanks to the Community Spouse Resource Allowance.

Reasons for Failing Renewals

Approximately 25% of Medicaid beneficiaries fail to renew their benefits during the Renewal process. There are several reasons this might happen, but roughly 70% lose their benefits due to procedural issues, which include:

• Not receiving the Renewal notice because of a change of address
• Not completing the Renewal Form on time
• Completing the Renewal Form incorrectly

Individuals can also lose their benefits during Medicaid Renewal if they no longer meet their financial eligibility requirements. There are many ways this can happen, but some of those most common are:

• Inheriting money
• Inheriting an asset
• Increase in home value
• Accumulation of monthly income leading to increased assets
• Increase in monthly income (this is rare because most Medicaid beneficiaries have a fixed income)

Consequences

If a Medicaid Renewal is not successful, benefits will stop in the first month after the Renewal Date. Most states will not take this step without giving at least 15 days’ notice, so if the Renewal date falls at the end of a month and the individual is found ineligible, they will be given a grace period instead of losing their benefits as soon as the next month begins.

From the day the benefits stop, individuals have another 90 days to submit or resubmit their Renewal Form. This gives them a chance to be re-enrolled in Medicaid without needing to re-apply. If they do not submit or resubmit their Renewal Form within 90 days, or if they do and are still found ineligible, they will need to re-apply for Medicaid.

For Nursing Home Beneficiaries

Being found ineligible during a Renewal can lead to an eviction for Nursing Home Medicaid beneficiaries. Every nursing home has its own policies, but most facilities begin the eviction process within 30 days if the resident’s bill is unpaid. The median cost for a semi-private room in a nursing home in the U.S. in 2025 was $9,581/month, according to the latest cost of care statistics from Genworth and CareScout.

For HCBS Waiver Beneficiaries

Most Medicaid beneficiaries who need a Nursing Facility Level of Care (NFLOC) but live at home or in some type of assisted living receive their benefits through an HCBS Waiver. If these beneficiaries fail their Renewal, not only will they lose their benefits, they may also have to wait in line for coverage after they re-apply. Many HCBS Waivers have a limited number of enrollment spots, and once those spots are full, any additional applicants will be placed on a waitlist. So, even if an applicant is qualified, they will only receive benefits if the Waiver has open enrollment spots. This includes individuals who were already in the program but were unenrolled after being found ineligible during their Renewal.

Losing Eligibility Outside of Renewals

It’s important to note that Medicaid beneficiaries are required to report any changes in assets or income – such as an inheritance, increase in home value or additional income – within 10-30 days of the change, even if it is not time for Renewal. Failing to promptly report financial changes can lead to a loss of Medicaid benefits and coverage.

Individuals in this situation may be able to have their benefits reinstated without needing to re-apply, depending on the circumstances and the state. If the financial change was minor, the state may allow the individual to adjust their finances (spend down excess assets, for example) in order to maintain their benefits and continuous coverage. However, failure to report a financial change could result in the beneficiary needing to re-apply for Medicaid. This means, as mentioned above, nursing home residents could be evicted, and those receiving Medicaid benefits at home, in assisted living or elsewhere in the community via a HCBS Waiver could end up at the bottom of a waitlist when they re-apply.

In some cases, Medicaid beneficiaries who fail to report financial changes can be fined or even face jail time.

How We Can Help

We’re an integrated team of Certified Medicaid Planners, financial advisors and legal consultants with years of experience working with seniors, Medicaid Renewals and Medicaid systems all across the country. For clients who enroll in the Renewal Subscription Service, our team of experts will manage the entire Renewal process to ensure benefits never lapse. This includes gathering all the necessary financial paperwork, completing the Renewal Form, and managing all follow-ups with the state, including appeals and hearings.

The Renewal Subscription Service also includes monthly consultations that clients and families can use to:

• Navigate asset limits and spend down rules after receiving an unexpected financial inheritance or gift
• Successfully transition from home care to assisted living while preserving Medicaid eligibility
• Receive advice on how a community spouse can legally protect assets, even during a home sale
• Quickly resolve any time-sensitive “Request for Information” (RFI) notices from the state