Every person enrolled in Medicaid must have their eligibility reconfirmed at least once a year. This process is called a redetermination, or simply a renewal. The state checks whether your income, household size, and other circumstances still qualify you for coverage. It sounds routine, but it is the single biggest reason people lose Medicaid, and most of those losses have nothing to do with whether the person still qualifies.
Ex Parte Renewals: The Automatic Path
Federal rules require states to first try an ex parte renewal. This means the state attempts to reverify your eligibility using data it already has, such as wage records, tax data, and Social Security information. If the data confirms you still qualify, your coverage is renewed automatically and you receive a notice. No form, no action needed.
The catch is that ex parte rates vary enormously between states. Some states automatically renew more than 70 percent of their caseload; others manage under 30 percent. A low ex parte rate means more people get pushed into the manual renewal path, where the risk of losing coverage spikes.
The Manual Path and Procedural Disenrollment
When the state cannot confirm eligibility through data, it mails a renewal packet. The enrollee must complete it, attach any requested documents, and return it by a deadline. If the packet never arrives because of a stale address, if it is too confusing, or if a required document is missing, the person is dropped. This is called a procedural, or paperwork, disenrollment.
Procedural disenrollment is the core problem in coverage retention. The person may be fully eligible, but a logistical breakdown ends their coverage anyway. During the Medicaid unwinding that followed the pandemic, the majority of disenrollments nationwide were procedural rather than based on a finding of ineligibility.
Understanding this distinction matters because the fix is different for each. Reducing ineligibility-based losses requires policy change. Reducing procedural losses requires better communication: accurate addresses, plain-language notices, multilingual outreach, and reminders before the deadline. The second category is where engagement work has the greatest, most immediate impact, and it is almost entirely preventable.