The open enrollment period (OEP) for health insurance Marketplaces will run from November 2023 to January 2024. This OEP will take place while most states are also conducting Medicaid renewals during the unwinding of the Medicaid continuous coverage requirement. State Health and Value Strategies has created sample messages and accompanying social media graphics to support states during the simultaneous Medicaid unwinding and open enrollment period. States can use this content in their outreach efforts to communicate important Marketplace enrollment opportunities to consumers, including those that may transition from Medicaid coverage.
As many states are implementing mitigation strategies to ensure compliance with the federal requirement to conduct ex parte renewals at the individual level, SHVS created model Medicaid reinstatement notice language which is intended to provide states with models for communicating key information to enrollees regarding their reinstatement. States can tailor and modify the templates for their programs and specific mitigation plans. The expert perspective also includes tips for writing and disseminating effective notices, based on enrollee feedback.
The Nebraska Department of Health and Human Services Division of Medicaid and Long-Term Care will host the next Medicaid listening tour throughout October and November 2023 in communities around the state. During the listening tour—which will include 12 meetings in 10 cities throughout Nebraska, along with two virtual sessions—Nebraska Medicaid will be announcing upcoming changes to the program and providing updates on the continuous coverage unwind.
The Colorado Department of Health Care Policy and Financing announced changes to its renewal packets to reflect feedback from members and advocates. Changes will be reflected in renewal packets sent mid-October, including fewer blank spaces and fewer pages, additional emphasis to sign the renewal packet, and the addition of a color Colorado state seal to the renewal packet envelope window to help prevent it from being mistaken for junk mail.
In a new National Association of Medicaid Directors (NAMD) blog post, NAMD Executive Director Kate McEvoy discusses the current state of Medicaid unwinding and lifts up where priorities at all levels are aligned and what states are doing to innovate and course correct to improve the redetermination process for Medicaid members. McEvoy emphasizes that state and territory Medicaid staff are central to this effort and remain actively and dynamically at work. This includes learning from unwinding data and experience, issue spotting and responding to feedback from members and partners, and proactively collaborating with both federal partners and the myriad entities—managed care organizations, healthcare providers, community-based organizations, and advocates—that are essential to achieving the shared goal of coverage retention.
As states are working diligently to operationalize the unwinding of the Medicaid continuous coverage requirement, State Health and Value Strategies has been tracking the creative strategies states are implementing to minimize coverage losses. This expert perspective highlights all the hard work states are engaged in and spotlights innovative strategies other states may want to consider adopting. SHVS will continue to track and share state efforts to support coverage through the unwinding period. If your state is implementing a new effort to reach enrollees, or if you have questions about how you can implement an example included in this EP, please be in touch.
Given the potential to reduce coverage losses during the unwinding, there is intense interest in data that monitors transitions between Medicaid and Marketplace coverage. State-Based Marketplaces (SBMs) that operate their own eligibility platform should consider releasing available data on Marketplace transition outcomes. This expert perspective highlights recommendations for SBMs, such as providing context and making the data easy to find. The expert perspective includes an interactive map with links to SBMs reporting Marketplace transition outcome data and a table of the indicators that states are reporting on. SHVS will continue to update this EP as more SBMs publish unwinding data.
The unwinding of the Medicaid continuous coverage requirement represents the largest nationwide coverage transition since the Affordable Care Act, with significant health equity implications. Given the intense focus on coverage transitions during the unwinding, some states are publishing their data to monitor progress. To date, 42 states (including the District of Columbia) have released unwinding data in either an interactive dashboard or static pdf format, or are making public their required CMS Monthly Unwinding Data reports. This expert perspective includes an interactive map with links to state dashboards and reports to CMS. SHVS will continue to update this EP as more states publish their unwinding data.
CMS is calling to action every state and federal agency that works with children and families to engage directly and through partners during the unwinding to maintain coverage.
The Kentucky Health Benefit Exchange created a “Back-to-School” outreach flier to inform families who are enrolled in Medicaid or CHIP coverage that their renewal letter will be coming soon and the actions they need to take to remain covered. The flyer, which is also available in Spanish, includes contact information and a QR code directing individuals to more information about the unwinding.
This expert perspective describes how states can use consumer surveys to better understand coverage transitions during the unwinding. The EP highlights survey recommendations, such as survey mode, target population and timing, communications best practices and agency coordination, and includes a list of sample survey questions for states to download.
Medicaid, CHIP, Marketplace and integrated human services call centers are experiencing a surge in the number of callers seeking information about their health coverage with the end of the Medicaid continuous coverage requirement. In some states, high call volume is translating into long wait times and high rates of call abandonment, adversely affecting Medicaid and CHIP enrollees who rely on the call center as a critical source of assistance and support. Recognizing the crucial role of call centers in supporting enrollees throughout the eligibility and enrollment process, states can use this toolkit to identify opportunities and explore strategies to improve call center functionality.
A secret shopper study conducted by researchers at Georgetown University suggests that former Medicaid enrollees searching for new health plans on the private market are facing aggressive and misleading marketing of limited benefit products that fail to protect consumers from the steep cost of healthcare. The study conducted in June 2023 indicates that online searches for health insurance led to websites and solicitations from sales representatives promoting limited benefit products, rather than the Affordable Care Act Marketplace.
On July 28, 2023, the Centers for Medicare & Medicaid Services released publicly state-reported data providing a window into how the unwinding of the federal Medicaid continuous coverage requirement is progressing. This expert perspective summarizes the data release, provides a timeline for CMS’ continued release of unwinding data and highlights the importance of context and the imperative for stakeholders to tread carefully when making interpretations about the data.
The Institute for Medicaid Innovation released findings from their survey of Medicaid health plans. The survey, supported by the Robert Wood Johnson Foundation, asked plans how they are handling the redetermination process in an effort to identify best practices. The national survey captures information that can be used to inform federal and state policymaking and provides insight on the barriers, challenges, and successes health plans are experiencing related to Medicaid redeterminations. This is the first in a four-part series of surveys related to the unwinding of the Medicaid continuous coverage requirement.
The New York State Department of Health released the first issue of the state’s “Public Health Emergency Unwind Dashboard,” a monthly report reflecting data on renewal status, demographics and program transitions for public health insurance enrollees. The report indicates that roughly 72% of New Yorkers enrolled in Medicaid, Child Health Plus or the Essential Plan renewed their coverage before the June deadline to re-enroll.
The District of Columbia Department of Health Care Finance announced during a bi-weekly Medicaid renewal community meeting that it is conducting dedicated outreach to special populations, including senior enrollees, enrollees living with disabilities, and enrollees experiencing homelessness.
The Wyoming Department of Health is reminding Medicaid enrollees, family members, providers and case managers that services provided to certain populations through waiver programs are part of Wyoming Medicaid and individuals need to return their renewal forms to avoid loss of coverage.
The Mississippi Division of Medicaid announced that approximately 56% of the enrollees in the June review month retained coverage. Of the more than 29,000 who were disenrolled, at least 60% were individuals whose coverage had previously been extended because of the special eligibility rules during the public health emergency.
The Minnesota Department of Human Services announced that efforts to reach enrollees regarding Medicaid unwinding have so far included over 92,000 text messages and 290,000 paper notices through the mail. Partners are also reaching out through direct phone calls, texts, emails and in-person contacts in some locations.
The Michigan Department of Health and Human Services (MDHHS) announced that as of July 6, the state renewed Medicaid coverage for 103,540 people. That includes 30,456 renewals for enrollees who submitted their paperwork and 73,084 for people who were renewed by MDHHS because the department already had necessary information required for eligibility.
CMS published a summary of the mitigation strategies 35 states adopted to comply with Medicaid renewal requirements. The summary highlights specific areas where states were deemed out of compliance with the federal renewal requirements, and states’ primary, high-level mitigation strategies. Of note, nine states paused procedural terminations as part of their mitigation plan and 16 states did not identify areas of non-compliance and therefore did not adopt mitigation strategies.
CMS, the Department of Treasury and the Department of Labor released a letter to employers and issuers encouraging unwinding outreach and other best practices.
The Minnesota Department of Human Services is sending $36 million to support county and Tribal efforts to renew Minnesotans’ health insurance. The funds will cover costs such as addressing health disparities, hiring and training staff, paying overtime and reaching out to enrollees.
The unwinding of the Medicaid continuous coverage requirement represents the largest nationwide coverage transition since the Affordable Care Act, with significant health equity implications. Given the intense focus on coverage transitions during the unwinding, some states are publishing their data to monitor progress. To date, 32 states and the District of Columbia have released unwinding data in either an interactive dashboard or static pdf format, or are making public their required CMS Monthly Unwinding Data reports. This expert perspective includes an interactive map with links to state dashboards and reports to CMS. SHVS will continue to update this EP as more states publish their unwinding data.
A slide deck with account transfer strategies. CMS encourages states with State-Based Marketplaces to consider exchanging information on procedural terminations and jointly conducting outreach—including with regard to the 90-day reconsideration period for individuals terminated from Medicaid/CHIP.
New York State of Health, the state’s official health insurance Marketplace, created a webpage with information for employers on the unwinding. The webpage includes information for employers that offer insurance coverage to their employees and where to direct employees if employer-sponsored coverage is not offered. Resources include a fact sheet for employees, frequently asked questions for employers and a letter to employers on redeterminations and coverage.
Nevada Health Link, the state’s official health insurance Marketplace, Nevada Medicaid and the Division of Welfare and Supportive Services issued a press release about how the state agencies are working together to keep Nevadans insured during the unwinding. During the months of April and May, 94% of those who applied for health coverage after being transferred to the Marketplace from Medicaid were found eligible to enroll, and 74% of those who applied were additionally found eligible for financial assistance.
The Minnesota Department of Human Services announced it will extend the deadline to renew Medicaid for 35,500 people whose renewal paperwork is overdue for July 1 coverage. The state is working with the federal government to avoid ending coverage for people who may still qualify, but face barriers such as not receiving the form in the mail.
With the restarting of eligibility redeterminations, millions of Medicaid enrollees are now at risk of losing their coverage and there is intense interest in monitoring the impact on coverage. As unwinding data is becoming public, it is difficult to compare across states as they are staging redeterminations in different months and states are using different terminology, definitions, and population denominators on their reporting. This expert perspective highlights recommended best practices for states to follow such as the timely release of data, prioritizing key measures, publishing disaggregated data, and providing context and transparency.
The unwinding of the Medicaid continuous coverage requirement represents the largest nationwide coverage transition since the Affordable Care Act, with significant health equity implications. Given the intense focus on coverage transitions during the unwinding, some states are publishing their data to monitor progress. To date, 29 states and the District of Columbia have released unwinding data in either an interactive dashboard or static pdf format, or are making public their required CMS Monthly Unwinding Data reports. This expert perspective includes an interactive map with links to state dashboards and reports to CMS. SHVS will continue to update this EP as more states publish their unwinding data.
CMS has updated their Communications Toolkit and related materials to support enrollee education and outreach in multiple languages.
This CMS resource urges partner efforts to promote coverage retention.
To ensure Massachusetts residents retain their health coverage during the unwinding, the state has created the “MassHealth Redetermination Campaign,” a collaboration between MassHealth, the Massachusetts Health Connector (the state’s official health insurance Marketplace), Health Care for All, community-based groups and health providers.
The South Carolina Department of Health and Human Services is warning the community about current Medicaid renewal scams that may target Medicaid members. The state is sending texts to let Medicaid members know their annual review form is in the mail and prompt them to complete the form. Those who receive an email or text asking to pay money or provide gift cards to keep or renew their coverage are instructed to contact the state’s Medicaid fraud hotline.
CoverME.gov, the state’s official health insurance Marketplace, created a consumer enrollment guide for individuals no longer eligible for Medicaid during the unwinding. The guide instructs individuals on how to create an account, access an existing application that the Department of Health and Human Services may have sent to the Marketplace, enroll in the special enrollment period available for those who lost Medicaid, choose a plan, and access financial assistance through the Marketplace.
Covered California, the state’s official health insurance Marketplace, launched a virtual media tour to spread the word about the upcoming Medi-Cal to Covered California enrollment program and how to keep Californians covered. A new, multilingual ad campaign was also launched to educate consumers and make sure they understand how they can stay insured. The campaign highlights how Covered California will help consumers through every step of their transition, and provide quality coverage, at low or no cost for many.
As states continue the unwinding of the Medicaid continuous coverage requirement and redetermining their enrollees, states across the country have reported scams asking consumers for financial or personal information are prevalent. This expert perspective provides recommendations on what state communications and digital teams can do to mitigate online scams and protect official sources of information.
Kentucky is hosting monthly stakeholder meetings throughout the unwinding of the Medicaid continuous coverage requirement. During the May stakeholder meeting, the Cabinet for Health and Family Services presented on the state’s renewal caseload planning, priorities, renewal updates, outreach, reporting to CMS, and how providers can support patients through renewals.
For individuals who receive a notice that they are no longer eligible for Medicaid or MinnesotaCare, MNsure has created a guide on how to get new coverage through the Marketplace with information about the available special enrollment period, free enrollment help through a MNsure-certified assister, and available financial assistance through the Marketplace.
The Kentucky Cabinet for Health and Family Services released a Medicaid renewals snapshot which includes data on the number of passive and active renewals, the number of mailed notices and emails the state has sent, and phone calls made to Medicaid members, and the anticipated renewal case counts for each month through April 2024.
CCIIO released guidance that provides operational details for unwinding for enrollees in Marketplaces using the federal platform, which are also applicable to State-Based Marketplaces.
As states have begun reporting on changes in enrollment as a result of unwinding, the article highlights strategies states, the federal government and community partners can employ to limit the loss of coverage among people who are eligible, and connect individuals no longer eligible for Medicaid to other sources of coverage.
Dr. Richard Besser, President and CEO of the Robert Wood Johnson Foundation co-authored an op-ed highlighting that 5 million children are at risk of losing coverage as a result of the unwinding. The op-ed encourages governors to take measures to ensure eligible children maintain their coverage.
Host Heather Howard, a professor at Princeton University and former New Jersey Commissioner of Health and Senior Services, discusses the unprecedented transition with Kate McEvoy, Executive Director of the National Association of Medicaid Directors, and Dr. Kemi Alli, a pediatrician and Chief Executive Officer of Henry J. Austin Health Center, a federally qualified health center in Trenton, New Jersey. They talk about strategies for maximizing continuity of coverage for consumers — along with who is most likely to slip through the cracks, the role of state health officials and health care providers, and the potential impact on public health.
Automated phone systems, when well designed, can efficiently provide information or direct callers to a person who can help. But if a phone tree has too many options or tries to convey too much information, it makes it difficult for people to get the help they need. A new blog post from the Georgetown University Center for Children and Families details the findings from two rounds of calls to state Medicaid call centers to see what consumers encounter when they call the hotline. Specifically, the authors wanted to know if the call center offers a call back option; prompts for non-English speakers; a separate dial option to update contact information; or reports the approximate wait time or the caller’s place in a queue. The blog post features a map to see which of the four key call center features each state has implemented as they unwind the Medicaid continuous coverage requirement.
As a result of the Medicaid renewal process, which resumed in April 2023, it is expected that millions of people across the country will lose Medicaid and in some cases, CHIP coverage. This presents State-Based Marketplaces (SBMs) with an opportunity to target outreach efforts to those audiences who have recently lost Medicaid or CHIP to help eligible individuals retain access to affordable healthcare through the Marketplace. This new expert perspective focuses on best practices for timing and strategy in consumer outreach to consumers that are no longer eligible for Medicaid to help states develop a consumer “chase campaign”.
The Pennsylvania Department of Human Services (DHS) and Pennie (the state’s official health insurance Marketplace) announced a collaborative multichannel, long-term outreach strategy to raise awareness of the critical need for Pennsylvanians to complete their Medicaid and CHIP renewals on time when it is their turn to maintain healthcare coverage. Advertisements span English and Spanish-language television and radio, video and music streaming platforms, social media channels, public transit systems, and billboard placements around the Commonwealth.
These animated videos may be used by states across social media and digital platforms to reach enrollees with important information about the continuous coverage unwinding. Key messages encourage consumers to update their contact information and look in the mail for updates about Medicaid renewals to avoid gaps in their coverage. Videos are created in 15, 30, and 60-second lengths and are available in English and Spanish. States may customize the end card of each video by contacting Laura Buddenbaum at firstname.lastname@example.org to connect with our communications TA partners providing customizations.
GetCoveredNJ, the state’s official health insurance Marketplace, created a list of frequently asked questions (FAQs) on the loss of NJ FamilyCare (Medicaid/CHIP) during the unwinding. The FAQ informs enrollees of a 120 day special enrollment period to enroll in coverage through GetCoveredNJ after Medicaid or CHIP coverage ends.
Kentucky communications resources for the Medicaid unwinding.
This plan outlines Kentucky’s planned approach and processes to achieve three PHE unwinding goals: comply with CMS requirements, prevent administrative terminations, and transition ineligible individuals to alternative coverage.
The Marketplace has step-by-step instructions for individuals referred from Medicaid to the Marketplace during the unwinding.
On April 4, the U.S. Department of Health and Human Services (HHS) Office for Civil Rights (OCR) issued a letter reminding states (and other entities subject to federal civil rights laws) of their obligations at the end of the Medicaid continuous coverage requirement with respect to: (1) providing equal access for communities of color and language access for individuals with limited English proficiency (LEP); and (2) ensuring effective communication with individuals with disabilities. The letter also highlights best practices (starting on page 5) to ensure that people of color and individuals with LEP or disabilities are not disenrolled during unwinding as a result of ineffective communications and provides a compendium of resources (starting on page 8) to support state efforts.
California updated its Medi-Cal Continuous Coverage Toolkit to include a section focused on renewals. The toolkit is available in 19 languages and includes materials that can be customized to help ambassadors and partners assist Medi-Cal members with the redetermination process. The content encourages members to update their contact information to ensure they receive important information about keeping their Medi-Cal coverage. The toolkit includes flyers, social media posts, messaging, including interactive voice response call scripts, sample emails, and text messages.
Google recently announced it is highlighting Medicaid renewal-related information in relevant search results to make the information easier for consumers to find. This expert perspective provides more information on the new search features and how state health agencies can ensure their landing pages appear in Google search results related to Medicaid renewal.
The Alaska Division of Public Assistance created a webpage to inform Medicaid enrollees about the continuous coverage unwinding.
The Department of Social Services and Access Health CT shared a comprehensive 12-month operational and outreach plan to redetermine eligibility for HUSKY Health (Medicaid) enrollees and resume routine public program operations. Less than a quarter of the approximately 434,000 Connecticut residents being redetermined are expected to no longer be eligible.
The Department of Social Services created a webpage “Update Us, so we can Update U” for enrollees in HUSKY Health to update their contact information during the unwinding.
The Massachusetts Health Connector created a website dedicated to unwinding the Medicaid continuous coverage requirement that includes resources for individuals and families to take action to stay covered, resources for employers and employees, and a toolkit with member-facing materials for redeterminations.
MassHealth has created member-facing materials available in multiple languages to spread the word about redeterminations.
Nevada Health Link, the state’s official health insurance Marketplace, announced an estimated 200,000 Nevadans may be redetermined ineligible for Medicaid benefits over the next 14 months. For individuals who are not renewed for Medicaid coverage, Medicaid will contact individuals to advise them of their account transfer and Nevada Health Link representatives will do active outreach to those individuals to help them with next steps regarding their account.
The New York State Department of Health announced that beginning this spring and continuing through spring 2024, more than 9 million New Yorkers enrolled in Medicaid, CHIP and the Essential Plan (the state’s Basic Health Program) will need to renew their health insurance. Renewal notices will be sent on a rolling basis and renewal deadlines will be based on the enrollees’ enrollment end dates and will range from June 30, 2023, through May 31, 2024. Consumers are encouraged to renew by the 15th of the month.
The National Health Law Program compiled a list of continuous coverage unwinding guidance and resources for advocates. Resources have been compiled from the Centers for Medicare & Medicaid Services (CMS), other federal agencies, and advocacy organizations, including the National Health Law Program.
The Louisiana Department of Health announced that Louisiana Medicaid will start using text messages to send members important reminders about their health insurance coverage. These text messages may include reminders about renewals and reminders to update contact information.
The Colorado Department of Health Care Policy & Financing announced they began sending text message reminders to Medicaid members who need to complete renewal paperwork to see if they still qualify for health coverage
The Kansas Department of Health and Environment announced that they have increased communication with KanCare (Medicaid) enrollees, healthcare providers, and other stakeholder groups in regular contact with the enrollee community to share information regarding the resumption of eligibility reviews. In addition, KanCare has updated its website to make it easier for people enrolled in Medicaid to update their contact information and complete the verification process.
Executive Director Kim Bimestefer of the Colorado Department of Health Care Policy & Financing (HCPF) issued a message to stakeholders on the end of the Medicaid continuous coverage requirement, describing the state’s compliance with CMS’ criteria for obtaining enhanced federal matching funds. The notice also shares communication resources, such as awareness posters and social media images, and encourages stakeholders’ active engagement in raising Medicaid enrollees’ awareness of the upcoming renewals and in helping connect those who no longer qualify to other forms of coverage.
To maximize efforts to maintain coverage, state Medicaid agencies and Marketplaces can now leverage digital channels as part of their overall outreach and communications efforts. Rapidly evolving changes in consumer media consumption habits as well as shifts in digital channels, and the ability to leverage data sources, enables granular audience targeting and efficient use of resources. These can be incorporated into an overall integrated outreach and education campaign to maximize renewals and coverage retention.
Rhode Island created a new webpage to inform Medicaid enrollees about the continuous coverage unwinding.
Maine’s unwinding webpage which provides important resources to help inform people with MaineCare about the steps they need to take to avoid losing coverage.
The Maine Department of Health and Human Services published a communications toolkit for community-based organizations, partners, providers, and other stakeholders to inform MaineCare (Medicaid) enrollees about the upcoming renewal process.
The Pritzker administration is launching an all-out public awareness initiative to ensure Illinoisans retain their health insurance coverage when Medicaid eligibility verifications resume. The Department of Healthcare and Family Services’ public effort, coined Ready to Renew, is a multi-platform outreach campaign that includes paid advertisements, print, digital and broadcast communication, and grassroots outreach to help Medicaid enrollees ensure they are ready for required upcoming coverage renewals.
The Department of Health Care Finance (DHCF), the District of Columbia’s state Medicaid agency, announced the start of a public awareness campaign to update enrollee contact information and renew their health coverage. The campaign will include grassroots outreach through neighborhood and citywide events; regular virtual meetings hosted by DHCF on Medicaid renewal; an advertising campaign that touches every Ward in the District that directs enrollees on steps to renew; and a “Stakeholder Communications Toolkit” to assist outreach from community-based organizations, government agencies, and other stakeholders who support and provide services to Medicaid enrollees.
The West Virginia Bureau for Medical Services created a webpage where it will post documents the state is required to submit to CMS, including the baseline and monthly unwinding data reports.
Iowa HHS posted resources concerning the state’s continuous coverage unwind plan. These materials are meant to help members navigate unwinding as seamlessly as possible. Materials currently available include a document that explains the state’s unwinding plan; a slide deck for stakeholders and their constituents; a toolkit of information and resources; how-to guides for members applying for the Medicaid program; previews of upcoming mailings members will receive; a frequently asked questions document; and printables for offices and bulletins.
The Washington State Health Care Authority (HCA) issued a call for volunteers from communities across the state to share messaging and ensure Apple Health (Medicaid) recipients have the information and resources they need to maintain coverage as the continuous coverage requirement ends. HCA invites volunteers to become an Apple Health Ambassador and help raise awareness.
The Colorado Department of Health Care Policy & Financing released the Take Action on Your Renewal toolkit to help community partners, stakeholders, and advocates spread the word about the continuous coverage requirement ending. The materials in this toolkit are designed to encourage members to look for their renewal packet in the mail and online portal and take action when they receive it and includes messaging outreach partners can share in their websites, newsletters, social media as well as direct-to-member email and text messaging communications.
The California Department of Health Care Services (DHCS) launched a statewide public information, education, and outreach campaign to raise awareness about the upcoming return of the Medi-Cal (Medicaid) eligibility renewal process. The statewide campaign will run from February 2023 through June 2024 and will reach across traditional and digital media channels. DHCS also launched a landing page, KeepMediCalCoverage.org, where Medi-Cal members can find out about the renewal process and how to update their contact information. Local county offices will begin mailing letters to members in April to let them know if their Medi-Cal coverage was renewed automatically or if they need more information to process the renewal.
On Wednesday, February 8, State Health and Value Strategies hosted a webinar during which experts from Manatt Health reviewed CMS’ recently released State Health Official (SHO) letter related to “unwinding” the Medicaid continuous coverage guarantee, based on provisions included in section 5131 of the Consolidated Appropriations Act, 2023 (CAA).The webinar reviewed the additional detail and operational expectations of states during the unwinding of Medicaid continuous coverage as laid out in the SHO letter, and discussed key considerations for state policymakers. As a reminder, SHVS has created a single-stop resource page to support states as they plan for unwinding.
On January 27, 2023, the Centers for Medicare & Medicaid Services (CMS) released a State Health Official (SHO) letter, “Medicaid Continuous Enrollment Condition Changes, Conditions for Receiving the FFCRA Temporary FMAP Increase, Reporting Requirements, and Enforcement Provisions in the Consolidated Appropriations Act, 2023.” This SHO letter is the second in a series of guidance related to section 5131 of the Consolidated Appropriations Act, 2023 (CAA), which established a fixed end date for the Medicaid continuous coverage requirement, a gradual phase-down for the enhanced federal match, and new guardrails for mitigating coverage loss for individuals who continue to be eligible.
Building on existing CMS guidance, the State Health Official letter details the requirements that states must comply with in order to receive the enhanced federal medical assistance percentage; clarifies expectations for states to comply with the Medicaid, CHIP, and marketplace reporting elements required by the CAA; and reviews implications of the CAA on select COVID-19 public health emergency-related flexibilities and authorities.
The Washington State Health Care Authority issued a notice about the end of Medicaid continuous coverage and the state’s expected timeline, with renewals beginning April 1, 2023.
The Virginia Department of Medical Assistance Services announced that some Virginia Medicaid members will receive renewal information in the mail beginning March 18, 2023, with disenrollments starting no earlier than April 30, 2023. The bulletin asks advocates to assist Medicaid members to understand the renewal process and complete any actions required as soon as possible.
The Department of Health Care Policy & Financing (HCPF) will be hosting an informational session on preparing for the end of the COVID-19 Public Health Emergency and its Continuous Coverage requirement. This webinar is geared toward community partners such as advocacy organizations, providers, and community organizations who may provide other assistance to Health First Colorado or CHP+ members (housing, social services, etc).
The Colorado Department of Health Care Policy & Financing issued an update to community partners on the return to renewals following the end of the Medicaid continuous coverage requirement, which includes information on the state’s timeline for unwinding continuous coverage, with noticing beginning in March and renewals due in May.
On January 23, 2023, the Federal Communications Commission issued an important ruling that provides states with new flexibility to support enrollee outreach and communication efforts as part of their processes to unwind the Medicaid continuous coverage requirement. The ruling permits state agencies and their partners to send text messages and make phone calls to individuals about enrollment-related issues not only for Medicaid but for other state-run health insurance programs, including marketplace coverage. This expert perspective reviews the ruling and implications for states.
The Federal Communications Commission issued a ruling that provides states with new flexibility to support enrollee outreach and communication efforts as part of their processes to unwind the Medicaid continuous coverage requirement.
Many consumers will find the relationship between Medicaid, the marketplace, and employer-sponsored insurance to be more complicated than ever in 2023 as the unwinding of the continuous coverage requirement begins. Much of the focus of Medicaid unwinding planning in states and the federal government has been on helping eligible people keep Medicaid coverage and steering the millions of people losing Medicaid eligibility toward the health insurance marketplace. Less attention has been devoted to the millions of people who are expected to be eligible for employer-sponsored insurance when their Medicaid coverage ends. This issue brief discusses how state Medicaid agencies, state-based marketplaces, labor departments, and employers can play critical roles in helping people understand and navigate their coverage options.
The Missouri Department of Social services created a webpage with communications resources for partners around the end of continuous coverage.
On Wednesday, January 11 State Health and Value Strategies hosted a webinar on the Consolidated Appropriations Act, 2023, an omnibus funding package that includes government appropriations through September 30, 2023 as well as a number of health policy provisions. Included in the package is a date certain for the expiration of the Medicaid continuous coverage requirement, a gradual phase down of the Families First Coronavirus Response Act enhanced federal match rate, and new guardrails to protect against inappropriate coverage loss and smooth coverage transitions.
TennCare, the state’s Medicaid program, issued a press release following passage of the Consolidated Appropriations Act, 2023 stating that it will be required to reverify the eligibility status of everyone receiving TennCare or CoverKids benefits beginning April 1, 2023. TennCare estimates that more than 1.7 million Tennesseans will be impacted by the process.
To avoid potential coverage losses when the federal public health emergency (PHE) is declared over and the Medicaid continuous coverage requirement ends, states will need to communicate with enrollees and other stakeholders, including community partners, about the actions they need to take to keep individuals enrolled in Medicaid or transition to another form of health coverage. This expert perspective reviews examples of states that are collaborating with community partners to support their outreach and engagement efforts.
A new report published by the Urban Institute finds that most adults with family Medicaid enrollment were not aware of the return to regular Medicaid renewals when the PHE expires. Researchers looked at data from the Health Reform Monitoring Survey from June 2022 to assess awareness of the resumption of Medicaid renewals, information sources about the change, and information about the change received by nonelderly adults who are covered by Medicaid or have a Medicaid-enrolled family member. Among the 37% of adults who had heard at least a little about the resumption of renewals, the most common source of information received was media, including social media, television, radio, and newspapers. Of those who had heard about the forthcoming change from state agencies or health plans, the information provided was most commonly a notification of the need to renew coverage. Low awareness of the resumption of Medicaid renewals indicates state programs may face significant information gaps among enrollees about the looming change.
The CO Department of Health Care Policy & Financinglaunched a partner communications toolkit to aid in preparing for the end of the PHE—Preparing for Renewals. This new toolkit includes a section on renewal process education that explains key terms and provides sample notices so partners can see exactly what the member will see when they go through the renewal process. In addition, both partners and members can view short videos in English and Spanish on key actions: updating an address, completing the renewal process, and transitioning to other coverage if a member no longer qualifies.
The Department of Human Services announced it will award mini grants to community-based organizations (CBOs) to engage Medicaid enrollees in preparation for the end of the public health emergency. The mini grants will support CBOs’ outreach and engagement efforts and assistance with the renewal process.
The Centers for Medicare & Medicaid Services (CMS) released a resource for states that adopted the optional COVID-19 group related to ending coverage when federal authority for the group expires on the last day of the COVID-19 public health emergency (PHE). This resource discusses coverage of the optional COVID-19 group, redetermination and notice strategies for the affected enrollees, and expectations for ending coverage in the group in states unwinding plans.
The impending end of the federal public health emergency (PHE) will be one of the most significant health coverage events since the implementation of the Affordable Care Act, as state Medicaid agencies across the country will resume regular renewal processes for over 89 million people. The resumption of redeterminations means that many Medicaid enrollees will need to affirmatively renew their coverage and those who are no longer eligible for Medicaid will need to transition to other forms of coverage or go uninsured. To help states effectively communicate with enrollees, this expert perspective provides research-based recommendations regarding terminology that can be used in consumer education and outreach.
This page provides communications resources designed to support states as they prepare for the various stages of work needed to inform stakeholders and consumers about the upcoming end of the Medicaid continuous coverage requirement. The end of the Medicaid continuous coverage requirement presents states with tremendous opportunities to keep individuals enrolled in Medicaid or transition to another form of health coverage.
At the end of the federal public health emergency, states will need to redetermine eligibility for nearly all Medicaid enrollees in the largest healthcare event since the Affordable Care Act. In order to avoid potential coverage losses, states will need to communicate with enrollees and other stakeholders about the actions they need to take to keep individuals enrolled in Medicaid or transition to another form of health coverage. One way that states are promoting transparency in their communications and planning efforts is through the public release of their unwinding operational plans. This expert perspective highlights several states that have made their unwinding operational plans publicly available as well as examples of states’ ongoing communication efforts, including outreach campaigns to Medicaid enrollees, strategies for collaborating with stakeholders, and collaborative initiatives within Marketplace states.
Kristen Challacombe, Deputy Director of Business Operations, appeared on the latest episode of “AHCCCS Explains” (a video series about the state’s Medicaid program) to explain what AHCCCS members can do to prepare for the end of the public health emergency.
This expert perspective focuses on strengthening communications to enrollees once the federal public health emergency is lifted and the continuous enrollment requirement ends to ensure that those who are eligible maintain their coverage, and those who are ineligible are transitioned to a Marketplace plan or other insurance. The intention is to help states develop a timeline within their communications plans to coordinate and sequence outreach to these consumer groups. Critical in this effort to reduce churn will be effective coordination with stakeholders. This expert perspective outlines outreach strategies and tactics state Medicaid agencies and State-Based Marketplaces can implement to effectively inform enrollees what is happening and what actions they may need to take to stay insured.
The Arizona Health Care Cost Containment System posted a summary of its Public Health Emergency Operational Unwinding Plan to inform stakeholders of the state’s plan for reinstating regular enrollment and operational procedures when the PHE ends. The summary and full operational plan are available on the Preparing for the End of COVID-19: Return to Normal Renewals webpage along with fliers, messaging toolkits, and other resources to help communities prepare for the end of the PHE.
The Department of Health Care Services released a request for information (RFI) seeking an experienced communications/advertising vendor to implement a broad and targeted education and outreach communications campaign for Medi-Cal (Medicaid) enrollees during and after the end of the COVID-19 PHE. Responses to the RFI are due by August 19, 2022.
The Department of Health Care Policy & Financing has created a toolkit to provide community partners, stakeholders, and advocates with messaging and resources to encourage Health First Colorado and Child Health Plan Plus members to update their contact information in advance of the end of the public health emergency.
This expert perspective, the second in a series about maintaining continuity of coverage and care during the public health emergency unwinding, identifies strategies for state-based Marketplaces (SBMs), in partnership with Medicaid agencies, departments of insurance, consumer assisters, and participating insurers, to help maintain continuity of care. The first expert perspective noted strategies that state Medicaid agencies can use to mitigate disruptions to coverage and care. A third expert perspective will discuss strategies for the SBMs and their partners to help ensure continuity of coverage.
This expert perspective, the first in a two-part series, outlines strategies state Medicaid agencies can take to identify people with high health needs and provide them with additional support to retain or transition their health coverage in order to maintain access to essential healthcare services when the current Medicaid continuous coverage requirement ends. A second expert perspective will identify complementary strategies state-based marketplaces and departments of insurance can implement to help these individuals transition without gaps in coverage or care.
The Centers for Medicare & Medicaid Services (CMS) released a new tool states can use to further prepare for the eventual end of the COVID-19 public health emergency (PHE) and return to normal Medicaid and Children’s Health Insurance Program (CHIP) eligibility and enrollment operations. Specifically, this tool highlights the ten fundamental actions states need to complete to prepare for unwinding when the Medicaid continuous enrollment requirement ends.
On May 17, 2022, the Department of Health Care Services (DHCS) released the Medi-Cal COVID-19 Public Health Emergency (PHE) Operational Unwinding Plan. The two primary purposes of this document are to: 1) describe DHCS’ approach to unwinding or making permanent temporarily flexibilities implemented across the Medi-Cal program during the PHE; and 2) describe DHCS’ approach to resuming normal Medi-Cal eligibility operations following the end of the PHE.
On May 3, 2022, the Federal Communications Commission (FCC) opened a public comment period for feedback on a letter submitted by the Department of Health and Human Services Secretary Xavier Becerra and Centers for Medicare & Medicaid Services Administrator Chiquita Brooks-LaSure. The letter requests the FCC’s opinion on the use of text messages and automated calls to enrollees as states resume regular operations at the end of the COVID-19 Public Health Emergency. This expert perspective provides model comments to inform and support state responses to the FCC’s public comment period.
This toolkit provides a communications planning guide designed to support state Medicaid agencies as they prepare for the upcoming end of the continuous coverage requirement. It outlines phases of planning to organize state efforts.
The Oklahoma Health Care Authority is preparing for the end of the Public Health Emergency (PHE) by asking all SoonerCare members to update their contact information and documentation.
Louisiana Medicaid has launched a phone campaign to encourage its members to update their contact information.
The New Hampshire Department of Health and Human Services created a webpage to host information on the unwinding of the federal Medicaid continuous coverage requirement, including sample member notices.
CA DHCS created a page on the unwinding of the federal Medicaid continuous coverage requirement, promoting a coordinated, phased communications plan to reach enrollees with messages across multiple channels using trusted messengers. The page includes a link to their Medi-Cal Continuous Coverage Toolkit.
The Centers for Medicare & Medicaid Services (CMS) released a new tool for states to utilize as they prepare to return to normal eligibility and enrollment operations after the COVID-19 public health emergency. The tool provides states with a summary of best & promising practices gleaned from discussions that CMS had with Medicaid agency leadership from each state, DC and three U.S. territories. The tool includes information on strategies states are implementing related to outreach, enrollee communications, renewals, updating enrollee contact information and addressing workforce issues to support their preparation for returning to normal eligibility and enrollment operations after the COVID-19 public health emergency.
The Virginia Department of Medical Assistance Services created an unwinding toolkit for healthcare plans, stakeholders, and government agency partners on preparing for the end of the public health emergency. The toolkit contains information and resources to guide stakeholders and advocates as they assist Medicaid members with the end of the public health emergency.
The Virginia Department of Medical Assistance Services announced information and resources for partners in preparing for the end of the public health emergency in the March edition of their Partner Points newsletter. The newsletter included a toolkit to guide stakeholders and advocates as they assist Medicaid members with the end of the public health emergency.
A report from the Kaiser Family Foundation and Georgetown University Center for Children and Families presents a snapshot of actions states are taking to prepare for the lifting of the continuous enrollment requirement, as well as key state Medicaid enrollment and renewal procedures in place during the PHE.
A new Urban Institute issue brief, co-authored by researchers from Georgetown University, examines preparations for the end of the PHE in 11 states with SBMs. The brief identifies major challenges state officials are facing and best practices for keeping people in coverage that could be adopted by the federally facilitated Marketplace and SBMs.
NY State of Health, the state’s official health insurance marketplace, has launched a new campaign to encourage consumers to “stay connected” with NY State of Health by signing up for text messages so they’ll know when it’s time to renew their health insurance. The ads also encourage New Yorkers to update their information in their NY State of Health accounts. After the federal PHE ends, consumers will once again need to take action to keep their coverage. This ad campaign is the first step NY State of Health is taking to connect with consumers regarding this change and help them avoid a coverage gap.
As state Medicaid and Children’s Health Insurance Program (CHIP) agencies develop their strategies for unwinding the federal Medicaid continuous coverage requirement under the Families First Coronavirus Response Act, many are looking to text messaging as a mechanism for outreach to their Medicaid and CHIP enrollees and communicating important information. This expert perspective describes states’ authority to send text messages and requirements for obtaining consent. The expert perspective also contains sample consent language to include in the Medicaid/CHIP application as well as template text messages.
On November 24, CMS released a “punch list” of strategies states and the US territories can adopt to maintain coverage of eligible individuals as they return to normal operations after the end of the public health emergency. The strategies are organized around seven topics areas: (1) strengthening renewal processes; (2) updating mailing addresses; (3) improving consumer outreach, communication, and assistance; (4) promoting seamless coverage transitions; (5) improving coverage retention; (6) addressing strains on the eligibility and enrollment workforce; and (7) enhancing oversight of eligibility and enrollment operations. In this resource, CMS also flagged strategies they expect to have the biggest impact on mitigating coverage losses.
On Wednesday, April 29 State Health and Value Strategies hosted a webinar, State Strategies to Support Medicaid/CHIP Eligibility and Enrollment in Response to COVID-19. Many states are experiencing an increase in the volume of Medicaid applications due to the COVID-19 pandemic and the resulting economic crisis. It is important for states to understand the policy and operational strategies they can use to ensure that people who are eligible for the Medicaid program can apply, enroll and start receiving benefits as quickly as possible. During the webinar experts from Manatt Health reviewed strategies states can use to manage and process an increased number of Medicaid applications, and the federal authorities that permit states to do so. Communications experts from GMMB reviewed strategies for messaging to new and existing enrollees. As a companion to this webinar, SHVS has also published a Medicaid COVID-19 Messaging toolkit.
On Thursday, January 21 State Health and Value Strategies hosted a webinar on the long-awaited guidance to state Medicaid and CHIP agencies on resuming normal operations following the end of the COVID-19 public health emergency. During the webinar experts from Manatt Health discussed the sub-regulatory guidance and the implications for states, in light of the recent public health emergency renewal by Secretary Azar. The webinar reviewed the expectations laid out in the guidance related to timelines, consumer communications, and fair hearing processes for redetermining Medicaid eligibility for those who have had their coverage continuously maintained as a condition of receiving the temporary 6.2 percent FMAP increase under the Families First Coronavirus Response Act. Additionally, presenters discussed the expected processes and timelines for terminating, or making permanent where allowable, temporary federal flexibilities that were obtained.
Updated Guidance Related to Planning for the Resumption of Normal State Medicaid, CHIP, and BHP Operations Upon Conclusion of the COVID-19 Public Health Emergency
Guidance on planning for the Resumption of Normal State Medicaid, CHIP, and BHP Operations Upon Conclusion of the COVID-19 Public Health Emergency
CMS Expanding Coverage Under Medicaid and CHIP: Materials developed by the Expanding Coverage MAC Learning Collaborative for states.