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Medicaid Recertification

What is Medicaid Recertification (renewal)?

Medicaid recertification (renewal) is the way your information is reviewed to make sure you are still  eligible for Medicaid health coverage. It is also called eligibility redetermination, renewal, ex-parté review  or case review (all mean the same thing). 

Recertification takes place every 6 or 12 months based on your Medicaid program. Your Medicaid caseworker will try to complete your recertification using information from electronic resources - without contacting you. 

If your Medicaid caseworker needs more information from you to finish your recertification, they will mail you a letter.

What You Need to Know

  • Make sure your local Department of Social Services (DSS) has your up-to-date contact information. They may need to reach you by mail, phone, email or text message about your recertification. Sign-up for an Enhanced ePASS account online to make changes to your information at any time without visiting your local DSS. To create an ePASS account, logon to epass.nc.gov. For more information about ePASS and how to create an account, see the ePASS fact sheet. 

  • Check your mail for information from your local DSS. If DSS needs information from you to finish your recertifcation, you will get a letter in the mail. Be careful and aware of scams.

    If you are not sure about information or mail you get asking for information from you, contact your local DSS. If your health coverage is renewed – You do not need to do anything. You will get a letter telling you your NC Medicaid benefits will stay the same or have changed. 

  • If your health coverage changes to a different Medicaid program – You do not need to do anything unless you do not agree or have concerns with your new Medicaid program. Contact your local DSS to learn more about your new benefit program. 

  • If your coverage is terminated (ended) – You can apply for health care coverage on the federal Health Insurance Marketplace at healthcare.gov. You can appeal the decision or reapply at any time.

Questions and Answers

Maybe. If you get a letter from your local DSS asking for more information, give them the information as soon as you can to make sure there isn’t a gap (pause) in your Medicaid health coverage

Look to see who the letter is from. (There are sample letters below this section.) If the letter is not from your local DSS, it may be a scam. Contact your local DSS to make sure it is from them. 

Yes. If you are on waiver, you must have your Medicaid eligilbity renewed to keep your waiver slot. 

Maybe. Your Medicaid eligibility is based on your income and your medical needs. If you have questions about your Medicaid case, ask your Medicaid caseworker for more information. 

You do not need to do anything. You will get a letter from your local DSS letting you know your Medicaid was renewed. You will continue to use your current Medicaid ID card to receive care. 

You can appeal your local DSS decision. You have up to 60 days from the date of the letter to ask for an appeal. If you file an appeal within 10 business days of the notice, your Medicaid may be continued while your appeal is reviewed.

Call, write or contact using ePASS your local DSS caseworker to ask for a hearing if you do not agree with the change. 

If your Medicaid has ended, you can apply for health care coverage from the federal Health Insurance Marketplace. Go to healthcare.gov to learn more. You also have the choice to reapply for Medicaid.

Local DSS Medicaid Letters (Notices)

You may get a Medical Assistance Renewal Notice from your local DSS with your information on the form. Your DSS may also ask for more information from you. You must respond (answer) to the request to have your recertification reviewed timely. 

If you need to change or add information, make the changes, sign and return the form to your local DSS. You have 30 days to respond (answer) to the first letter. If another letter is sent after the first letter, you must respond (answer) to it within 12 days.

If you have an enhanced ePASS account, make sure your information is correct online. For more information on ePASS and creating an enhanced account, read the What is ePASS? fact sheet. 

In some cases, your local DSS will send a Request for Information form for you to fill out. Add your information and return the form to your local DSS within 30 days.

More Information

Sign-up for an enhanced ePASS account online to make changes to your information at any time – without visiting your local DSS. To create an ePASS account, logon to epass.nc.gov. For more information about ePASS and creating account, read the What is ePASS? (PDF) fact sheet. 

Visit the NC Medicaid Beneficiary Portal for helpful articles and information about Medicaid. 

You can apply for health care coverage on the federal Health Insurance Marketplace at healthcare.gov. 

Contact the NC Medicaid Ombudsman if you have questions or problems your health plan or provider could not answer. Call 1-877-201-3750 or visit their website at ncmedicaidombudsman.org. 

Contact the NC Medicaid Enrollment Broker if you have questions about your health plan, want to learn more about your health care options and primary care providers or enrollment in NC Medicaid. Call 1-833-201-3750 or visit ncmedicaidplans.gov. 

Find your local DSS on the Local DSS Directory.