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 allowed people to retain Medicaid coverage and get needed care during the pandemic. On December 29, 2022, President Biden signed into law the Consolidated Appropriations Act, 2023 (CAA), an omnibus funding package that decoupled the continuous coverage provision from the end of the COVID-19 public health emergency by providing a fixed end date of March 31, 2023. These resources are designed to support states during this major coverage event, including developing processes that prioritize coverage retention. SHVS will update this page frequently with new resources as they become available. For more information about how states are unwinding the continuous coverage requirement, SHVS is highlighting examples of the work states are engaging in to prepare for and operationalize unwinding in our series States of Unwinding.
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 allowed people to retain Medicaid coverage and get needed care during the pandemic. On December 29, 2022, President Biden signed into law the Consolidated Appropriations Act, 2023 (CAA), an omnibus funding package that decoupled the continuous coverage provision from the end of the COVID-19 public health emergency by providing a fixed end date of March 31, 2023. These resources are designed to support states during this major coverage event, including developing processes that prioritize coverage retention. SHVS will update this page frequently with new resources as they become available. For more information about how states are unwinding the continuous coverage requirement, SHVS is highlighting examples of the work states are engaging in to prepare for and operationalize unwinding in our series States of Unwinding.
During the unwinding, the public release of state Medicaid renewal data provided new transparency into state eligibility and enrollment processes. States leveraged unwinding data to monitor coverage losses and adjust outreach and administrative enrollment policies. This expert perspective highlights examples of state reporting to offer approaches for states to adopt going forward.
Governor Dan McKee, the Executive Office of Health and Human Services, the Department of Human Services, and HealthSource RI highlighted key data and successes from the 14-month Medicaid unwinding. This includes an information sheet summarizing metrics on renewals, enrollment, continued coverage, outreach efforts and policy updates as well as a “year in review” data dashboard.
SHO #24-002 indefinitely extends state reporting of certain Medicaid and CHIP metrics required by the Consolidated Appropriations Act, 2023. The CAA reporting requirements on renewal outcomes were set to expire on June 30, 2024. CMS will also continue reporting state and national data publicly on renewal outcomes.
As states continue the process of redetermining Medicaid enrollees’ eligibility, researchers at SHADAC have been using monthly data from the Household Pulse Survey (HPS) to assist in tracking health insurance coverage rates during the unwinding. The blog presents rates of primary source of health insurance coverage by type and rates of no insurance as they are observed in the HPS. Estimates are presented at the state and national level by selected individual and geographic characteristics. The most recent analysis using data from March 2024 showed that uninsurance rates increased among Non-Hispanic White adults.
The Medicaid redetermination process is largely complete, but we are only beginning to understand the impact on enrollees and providers. A new brief for the Robert Wood Johnson Foundation’s Marketplace Pulse series examines data on pediatric encounters from a large network of community health centers to provide an early perspective on how coverage and payer mix is changing. Findings show a decline in the overall volume of Medicaid-insured visits and an increase in the share of visits from uninsured patients, with little variation among states.
CMS released a suite of Medicaid unwinding-related guidance and enrollment data that includes a focus on ensuring eligible children maintain Medicaid and CHIP coverage. In conjunction with CMS’ release, HHS sent letters to the governors of nine states with the highest child disenrollment rates, which accounted for 60% of the decline in children’s enrollment between March and September 2023. The letters encourage the nine states to adopt certain strategies to mitigate coverage loss for eligible children.
During the unwinding of the Medicaid continuous coverage requirement there has been a strong focus on monitoring the impacts of eligibility redeterminations. A review of public unwinding data identified nine states that are voluntarily reporting Medicaid reinstatement data—including reinstatements as a result of CMS guidance on conducting ex parte at the individual level, as a result of fair hearing cases, or re-enrollment into Medicaid and the Children’s Health Insurance Program within the 90-day reconsideration period. This expert perspective reviews current state reporting of reinstatement data and provides recommendations for the reporting of such data.
The Centers for Medicare & Medicaid Services released new data related to the unwinding of the federal Medicaid continuous coverage requirement, along with additional unwinding resources. This expert perspective reviews newly available Medicaid, Children’s Health Insurance Program (CHIP), and Marketplace data, and summarizes key findings pertaining to Medicaid and CHIP enrollment, applications, and renewals, as well as Marketplace transitions.
Many states are actively working to make changes to their systems to enable ex parte renewals at the individual level and implement mitigation strategies to ensure eligible Medicaid and CHIP enrollees retain coverage until those system changes are complete. This tool is intended to: (1) help states identify common policies and/or operational processes that, if adjusted, could improve ex parte rates and renewal functionality, and (2) facilitate internal, cross-divisional Medicaid agency discussions across policy, operational, and information technology systems.
On September 29, the Centers and Medicare & Medicaid (CMS) published a new release of state-reported Medicaid unwinding data through its Unwinding and Returning to Regular Operations after COVID-19 landing page. Like previous releases of data, CMS includes national and state-specific metrics pertaining to Medicaid and CHIP eligibility renewal outcomes and total enrollment in June (and preliminary data for July). This month, as part of its timeline of planned data releases, CMS newly shared more comprehensive data on Marketplace enrollment and transitions—including cumulative enrollment data between April and June for HealthCare.gov, State-Based Marketplaces, and the Basic Health Programs—and separate CHIP enrollment in April 2023.
To renew enrollees’ Medicaid coverage, states must first attempt to confirm ongoing eligibility using data available to the agency without requiring information from the individual. This requirement, also known as ex parte renewals, can reduce the administrative burden for states and simplify the process for enrollees. To understand the barriers to successful ex parte renewals and opportunities to improve them, the Medicaid and CHIP Payment Access Commission (MACPAC) contracted with Mathematica to conduct a roundtable with federal and state Medicaid officials and subject matter experts in June 2023. This issue brief describes the key themes and opportunities for improvement that emerged during the roundtable. Overall, participants agreed that improving the ex parte process in an important goal, but that there are a number of factors that complicate implementation and the issues may take some time to resolve.
The Oregon Health Authority announced that their latest renewal data continues to show that more than 7 out of 10 Oregonians are keeping their Oregon Health Plan or other Medicaid benefits. So far, around one in eight people’s benefits are ending. Compared with other states, Oregon has the third lowest benefit closure rate in the nation among completed renewals.
The Department of Health and Human Services announced that it reinstated coverage for Nevadans who recently had their coverage end because they did not return their renewal documentation. Due to a change in federal direction on policy in August, the Division of Welfare and Supportive Services (DWSS) was able to reinstate coverage for approximately 114,000 individuals. Individuals whose Medicaid coverage was reinstated this week will receive a notice in the mail from DWSS.
CMS published a table that presents preliminary state-reported information about the ability of states’ systems to conduct automatic renewals, otherwise known as ex parte renewals, at the individual level. As of September 21, 23 states and territories attested to correctly conducting ex parte renewals at the individual level, while 30 states and territories indicated they are not doing so or are still working to reinstate affected individuals.
The Minnesota Department of Human Services announced that nearly 50,000 Minnesotans took action to renew their Medicaid or MinnesotaCare (the state’s basic health program) coverage in the state’s first group to renew coverage since the COVID-19 pandemic. Coverage was extended until the fall for 10,000 enrollees who get their coverage based on having a disability, being blind or being aged 65 years or older as part of the state’s mitigation plan with CMS. Medicaid coverage ended for about 5,600 people who submitted forms and were found ineligible and for about 32,600 people whose status is unknown.
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.
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 Wisconsin Department of Health Services launched a new webpage showing statewide Medicaid enrollment data following the end of the continuous coverage requirement. The data on the new webpage show that in June, 99,037 members were due to renew their coverage and 61,057 members took some action to initiate the renewal process.
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 Georgetown University’s Center for Children and Families released a new interactive chart of state unwinding renewal data. The chart shows the share of ex parte renewals in which coverage is automatically renewed for an individual based on information in the enrollee’s case file or electronic data sources and the enrollee is not required to return a form or take action to maintain Medicaid coverage. This resource also shows the share of people being disenrolled for procedural versus eligibility reasons and the share of pending cases.
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 Mississippi Division of Medicaid posted the unwinding report it submitted to CMS for June 2023.
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.
The Maryland Department of Health announced that 28,694 individuals were disenrolled from Medicaid in June: 17,075 were disenrolled for procedural reasons while 11,619 were disenrolled because they are no longer eligible for coverage. Of the 98,630 individuals whose eligibility was renewed, 53.5% had their eligibility auto-renewed.
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.
The Arkansas Department of Human Services released its June report on Medicaid unwinding. In June, more than 50,000 cases were renewed after eligibility was confirmed, and approximately 77,000 enrollees were disenrolled.
The Arizona Health Care Cost Containment System (AHCCCS) released its monthly Medicaid renewal data dashboard detailing progress since the regular renewal process began in April. In the month of June, 67% of the renewals initiated were automatically determined to be eligible to maintain AHCCCS coverage. Approximately 25% of all individuals who have been disenrolled for not responding to AHCCCS have taken advantage of the 90-day window to finish their renewal.
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 Massachusetts Health Connector, the state’s official health insurance Marketplace, shared an update on Medicaid redeterminations and transitions to the Heath Connector during a June 8 board of directors meeting. As of June 5, a total of 34,645 individuals were found eligible for Marketplace coverage and 7,997 individuals, or 23%, enrolled in a plan.
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.
A Kaiser Family Foundation survey of Medicaid enrollees largely fielded prior to states resuming their efforts to redetermine Medicaid enrollees’ eligibility reveals many enrollees are unprepared for the renewal process that could result in some losing their coverage either due to eligibility changes or paperwork issues.
The Massachusetts Health Connector, the state’s official health insurance Marketplace, will be publishing reports to provide comprehensive and up-to-date information on plan selection, contact center summaries, and enrollment data during the unwinding. The first summary report was published on May 28.
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.
The Marketplace has step-by-step instructions for individuals enrolling in Marketplace coverage without a referral during the unwinding.
The Tracking Medicaid Enrollment Growth During the COVID-19 Pandemic Databook provides a comprehensive, detailed look at Medicaid enrollment trends to-date. Using Medicaid enrollment data from over 40 states, the Databook provides a comprehensive, detailed look at Medicaid enrollment trends from the beginning of the COVID-19 pandemic through December 2022. The Databook provides enrollment detail by state across four eligibility categories: expansion adults, children (including those enrolled in CHIP), non-expansion adults, and aged, blind, and disabled individuals. It also compares enrollment trends across expansion and non-expansion states. While variations in states reporting mean that the enrollment numbers in this report are not necessarily comparable across states (and should not be summed across states), the data reported do allow states and others to track enrollment trends. As a companion to the Databook, Manatt Health authored an issue brief, The State of Medicaid Enrollment Approaching Continuous Coverage Unwinding, that summarizes key findings from an analysis of the Databook.
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.
The tool aims to help states qualify for the sustained enhanced Federal Medical Assistance Percentage, avoid corrective action imposed by CMS, promote continuity of coverage and care during unwinding, and make long-term improvements to eligibility and enrollment infrastructure.
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.
Now that the details and timing associated with the unwinding of the Medicaid continuous enrollment requirement have been established by the Consolidated Appropriations Act, 2023 (CAA), states can start refining and implementing long laid plans to restart eligibility redeterminations and return to routine eligibility and enrollment operations. This expert perspective outlines the relevant reporting requirements that were included in the CAA and the corresponding reporting guidance provided by CMS in its January 2023 State Health Official letter, and presents considerations for state officials as they fulfill their federal obligations and address calls from advocates and others for transparency.
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.
New state reporting templates and guidance released by the Centers for Medicare & Medicaid Services (CMS) on March 22, 2022, build upon a State Health Official letter released on March 3. The resources specify both the data and the metrics that states will be required to submit to monitor enrollment and renewal efforts as they resume routine Medicaid and CHIP operations following the end of the COVID-19 PHE. This expert perspective summarizes the new reporting requirements and presents a set of considerations for states as they begin implementing new unwinding policies, procedures, and reporting.
The Centers for Medicare & Medicaid Services (CMS) released additional templates and resources to support state reporting around enrollment and renewal efforts when the federal public health emergency (PHE) concludes. The resources include 1) a “Renewal Distribution Report” form in which states will be required to summarize their renewal plans, with a focus on mitigating inappropriate coverage loss during the unwinding period and 2) an “Unwinding Eligibility and Enrollment Data Reporting” Excel workbook and specifications document, which aims to support states in reporting on certain metrics around timely application processing, renewal initiation and completion, reason for termination, and fair hearings. CMS also previewed that states will eventually report on these metrics on a monthly basis.
When the Families First Coronavirus Response Act Medicaid “continuous coverage” requirement is discontinued states will restart eligibility redeterminations, and millions of Medicaid enrollees will be at risk of losing their coverage. A lack of publicly available data on Medicaid enrollment, renewal, and disenrollment makes it difficult to understand exactly who is losing Medicaid coverage and for what reasons. Publishing timely data in an easy-to-digest, visually appealing way would help improve the transparency, accountability, and equity of the Medicaid program. This expert perspective lays out a set of priority measures that states can incorporate over time into a data dashboard to track Medicaid enrollment following the end of the continuous coverage requirement. For a detailed discussion of the current status of Medicaid enrollment and retention data collection and best practices when developing a data dashboard to display this type of information, SHVS has published a companion issue brief.
The Families First Coronavirus Response Act (FFCRA) Medicaid “continuous coverage” requirement has allowed people to retain Medicaid coverage and get needed care during the COVID-19 pandemic. When continuous enrollment is discontinued, states will restart eligibility redeterminations, and millions of Medicaid enrollees will be at risk of losing their coverage. The current lack of publicly available and timely Medicaid enrollment, renewal, and disenrollment data will make it difficult to understand exactly who is losing coverage and for what reasons. One effective way to monitor this type of information is through the use of Medicaid enrollment and retention dashboards. This issue brief examines the current status of data collection to assess Medicaid enrollment and retention, summarizes potential forthcoming reporting requirements, and describes some of the best practices states should consider when developing a data dashboard to display this type of information. The issue brief lays out a phased set of priority measures and provides a model enrollment and retention dashboard template.
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.
Following the expiration of the Public Health Emergency (PHE), states will resume normal eligibility and enrollment activities for all enrollees in Medicaid and the Children’s Health Insurance Program (CHIP). The volume of expected redetermination activity at the end of the PHE is unprecedented. This issue brief reviews state Medicaid/CHIP agency data and information technology (IT) system “table stakes”—strategies that will have the highest impact for states seeking to ensure that eligible enrollees are able to keep or transition to new affordable health coverage when the PHE continuous coverage requirements end. If adopted, these strategies will also enable states to dramatically improve Medicaid/CHIP enrollment and coverage retention in the longer-term for people eligible for government subsidized health coverage.
At the end of the public health emergency (PHE), people currently enrolled in Medicaid and the Children’s Health Insurance Program are at risk of losing their coverage unless state Medicaid/CHIP agencies take steps to update enrollee mailing addresses and other contact information. This expert perspective examines the information technology system, policy, and operational strategies states can consider to update key enrollee contact information to ensure eligible enrollees are able to keep or transition to new affordable health coverage at the end of the PHE.