Medicaid eligibility must typically be proven or renewed once every 12 months. This process, known as redetermination or renewal, requires beneficiaries to verify their financial, asset, andSometimes functional/medical information to ensure they still meet requirements.
MAGI Medicaid and CHIP Beneficiaries:States must renew eligibility once every 12 months and no more frequently than once every 12 months. Non-MAGI Medicaid Beneficiaries: States must renew eligibility at least once every 12 months.
Medicaid eligibility, however, is usually based on current monthly income.
Some states use a computerized system to cross reference a Medicaid applicant's reported income. For instance, in California, an electronic database, the Income Eligibility Verification System (IEVS), is used to match the income information provided by the applicant to other databases to verify it is accurate.
Annual Renewals: Medicaid beneficiaries must renew their eligibility every year. This process often includes submitting updated financial information. Medicaid will review your bank statements to ensure you meet the financial requirements. Periodic Reviews: Medicaid can conduct periodic reviews at any time.
Providers are responsible for verifying eligibility every time a member is seen in the office. PCPs should also verify that a member is assigned to them. Eligibility can be verified through the Recipient Eligibility Verification System (REVS).
Follows are the most common reasons for denial.
In most states, the Look-Back Period is five years long. This means the state officials who are reviewing your Medicaid application will “look back” into your financial history for the five years before you applied to make sure you haven't given away any money or assets, or sold them at less than fair market value.
During the look-back period, Medicaid may review credit card statements to verify expenses and ensure that no unexplained transfers or withdrawals were made.
Determining Eligibility for Medicaid
MAGI is the basis for determining Medicaid income eligibility for most children, pregnant women, parents, and adults. The MAGI-based methodology considers taxable income and tax filing relationships to determine financial eligibility for Medicaid.
Countable Assets
Medicaid programs consider certain assets to be exempt or “non-countable” (usually up to a specific allowable amount). Any cash, savings, investments and property that exceed these limits are considered “countable” assets and will count towards an applicant's $2,000 resource limit.
Eligibility verification is a vital front-end process that supports the entire healthcare billing lifecycle. By confirming a patient's insurance coverage and benefits before care is delivered, healthcare organizations can reduce denials, improve billing accuracy, and enhance the overall patient experience.
How to verify insurance eligibility and benefits
The most common reason an applicant is denied Medicaid is income or assets above the eligibility criteria. In most states in 2026, an applicant's monthly income must be less than $2,982/month, and their assets (including money in bank accounts) must be less than $2,000.
Medicaid Asset Protection Trusts (MAPT) help protect your assets from Medicaid. They are a type of irrevocable trust. Once you place assets in a MAPT, you can't change or take them back. This keeps those assets out of reach for Medicaid's estate recovery program.
Income-based NC Medicaid is for people with low incomes. These are the two main rules: If your family's income is at or below 138% of the Federal Poverty Guidelines (FPG) ($1,800 per month for an individual in 2026, $3,697 for a family of four), you may qualify for income-based NC Medicaid.