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Unwinding Resources for States

SHVS Resources and Tools Related to the Unwinding

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State Health and Value Strategies (SHVS) developed this resource page to serve as an accessible one-stop source of information for states in “unwinding” the Medicaid continuous coverage requirement. The Families First Coronavirus Response Act (FFCRA) Medicaid continuous coverage requirement has allowed people to retain Medicaid coverage and get needed care during the pandemic. Congress passed the Consolidated Appropriations Act (CCA) on December 23, 2023, an omnibus funding package that separates the continuous coverage provision from the COVID-19 public health emergency by providing a fixed end date of March 31, 2023. These resources are designed to support states planning for this major coverage event, including developing processes that prioritize coverage retention. SHVS will update this page frequently with new resources as they become available.

State Health and Value Strategies (SHVS) developed this resource page to serve as an accessible one-stop source of information for states in “unwinding” the Medicaid continuous coverage requirement. The Families First Coronavirus Response Act (FFCRA) Medicaid continuous coverage requirement has allowed people to retain Medicaid coverage and get needed care during the pandemic. Congress passed the Consolidated Appropriations Act (CCA) on December 23, 2023, an omnibus funding package that separates the continuous coverage provision from the COVID-19 public health emergency by providing a fixed end date of March 31, 2023. These resources are designed to support states planning for this major coverage event, including developing processes that prioritize coverage retention. SHVS will update this page frequently with new resources as they become available.

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PHE Unwinding

Missouri Unwinding Outreach Materials

The Missouri Department of Social services created a webpage with communications resources for partners around the end of continuous coverage.

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Date Created: Jan 13, 2023
PHE Unwinding

Omnibus Unwinding Provisions and Implications for States

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.

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Date Created: Jan 13, 2023
PHE Unwinding

TennCare to Restart Renewals

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.

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Date Created: Jan 9, 2023
PHE Unwinding

Communicating the PHE Unwinding: How States Are Collaborating With Community Partners

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.

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Date Created: Dec 20, 2022
PHE Unwinding

Most Adults in Medicaid-Enrolled Families Are Unaware of Medicaid Renewals Resuming in the Future

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.

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Date Created: Dec 20, 2022
PHE Unwinding

Preparing for Renewals: A Communications Toolkit

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.

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Date Created: Dec 20, 2022
PHE Unwinding

Arkansas DHS launches mini-grant program to assist with outreach to Medicaid clients ahead of Public Health Emergency ending

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.

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Date Created: Nov 14, 2022
PHE Unwinding

CMS Resource: Ending Coverage in the Optional COVID-19 Group

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.

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Date Created: Oct 20, 2022
PHE Unwinding

Recommended Terms for Direct-to-Consumer Unwinding Communications

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.

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Date Created: Oct 18, 2022
PHE Unwinding

Planning for the End of the Continuous Coverage Requirement: Communications Resources for States

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.

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Date Created: Oct 13, 2022
PHE Unwinding

Communicating the PHE Unwinding: How States Are Conducting Outreach and Planning

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.

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Date Created: Sep 8, 2022
PHE Unwinding

AHCCCS Explains the End of the Public Health Emergency

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.

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Date Created: Aug 12, 2022
PHE Unwinding

State Strategies for Sequencing Enrollee Communications When Medicaid Continuous Coverage Ends

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.

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Date Created: Aug 3, 2022
PHE Unwinding

Summary Public Health Emergency Operational Unwinding Plan

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.

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Date Created: Aug 1, 2022
PHE Unwinding

COVID-19 Public Health Emergency (PHE) Communications and Outreach Campaign

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.

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Date Created: Jul 26, 2022
PHE Unwinding

Colorado Update Your Address Campaign

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.

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Date Created: Jul 26, 2022
PHE Unwinding

Ensuring Continuity of Care for Individuals Transitioning from Medicaid to Marketplace: Post-PHE Considerations for States

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.

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Date Created: Jul 21, 2022
PHE Unwinding

Ensuring Continuity of Coverage and Care for High Need Enrollees When the Medicaid Continuous Coverage Ends: Medicaid Strategies

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.

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Date Created: Jun 1, 2022
PHE Unwinding

Top 10 Fundamental Actions to Prepare for Unwinding and Resources to Support State Efforts

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.

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Date Created: Jun 2, 2022
PHE Unwinding

Medi-Cal COVID-19 Public Health Emergency Operational Unwinding Plan

​​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.

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Date Created: May 20, 2022
PHE Unwinding

HHS Letter to the FCC on Text Messaging: Model Comments to Inform State Comment Letters in Support

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.

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Date Created: May 10, 2022
PHE Unwinding

Unwinding the Continuous Coverage Requirement: Developing a Communications Plan

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.

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Date Created: Apr 18, 2022
PHE Unwinding

SoonerCare Members are Encouraged to Update their Contact Information

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.

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Date Created: Apr 8, 2022
PHE Unwinding

Louisiana Medicaid Launches Phone Campaign

Louisiana Medicaid has launched a phone campaign to encourage its members to update their contact information.

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Date Created: Apr 8, 2022
PHE Unwinding

New Hampshire DHHS Post-Pandemic Benefits Changes Webpage

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.

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Date Created: Apr 8, 2022
PHE Unwinding

Medi-Cal Continuous Coverage Toolkit

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.

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Date Created: Apr 8, 2022
PHE Unwinding

Medicaid and CHIP Unwinding Planning Efforts

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.

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Date Created: Apr 8, 2022
PHE Unwinding

Federal Public Health Emergency Unwinding Toolkit

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.

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Date Created: Mar 31, 2022
PHE Unwinding

After the COVID Public Health Emergency: What Comes Next?

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.

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Date Created: Mar 25, 2022
PHE Unwinding

Medicaid and CHIP Eligibility and Enrollment Policies as of January 2022: Findings from a 50-State Survey

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.

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Date Created: Mar 18, 2022
PHE Unwinding

Preparing for the Biggest Coverage Event Since the Affordable Care Act

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.

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Date Created: Mar 18, 2022
PHE Unwinding

NY State of Health Launches Ad Campaign Urging Consumers to Sign Up for Text Alerts and “STAY CONNECTED”

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.

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Date Created: Feb 10, 2022
PHE Unwinding

Text Messaging: An Important Communication and Outreach Strategy as States Unwind the Federal Medicaid Continuous Coverage Requirement

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.

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Date Created: Feb 2, 2022
PHE Unwinding

Strategies States and the U.S. Territories Can Adopt to Maintain Coverage of Eligible Individuals as They Return to Normal Operations

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.

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Date Created: Dec 14, 2021
PHE Unwinding

State Strategies to Support Medicaid/CHIP Eligibility & Enrollment in Response to COVID-19 Webinar

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.

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Date Created: Oct 29, 2021
PHE Unwinding

New State Guidance on Resuming Normal Operations After the Public Health Emergency

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.

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Date Created: Oct 29, 2021
PHE Unwinding

Updated Guidance Related to Planning for the Resumption of Normal State Medicaid, Children’s Health Insurance Program (CHIP), and Basic Health Program (BHP) Operations Upon Conclusion of the COVID-19 Public Health Emergency

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

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Date Created: Oct 29, 2021
PHE Unwinding

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

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Date Created: Oct 29, 2021
PHE Unwinding

Expanding Coverage Under Medicaid and CHIP

CMS Expanding Coverage Under Medicaid and CHIP: Materials developed by the Expanding Coverage MAC Learning Collaborative for states.

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Date Created: Oct 29, 2021
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