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.
SHVS published an expert perspective that summarizes recently released CMS guidance detailing the timeline and expectations for states to fully comply with federal Medicaid and CHIP renewal requirements. CMS is requiring every state to submit by December 31, 2024 a plan that assesses state compliance with the federal renewal requirements and describes the state’s plan for addressing deficiencies to achieve full compliance by December 31, 2026.
This slide deck is intended to: 1) Provide an overview of and support state compliance with federal Medicaid and CHIP eligibility renewal requirements in place as of September 2024; 2) Serve as a supplementary resource to the State Compliance with Medicaid and CHIP Renewal Requirements by December 31, 2026 CMCS Informational Bulletin and additional, forthcoming guidance related to renewal compliance; 3) Acknowledge new federal regulatory requirements for completing renewals and associated compliance dates to assist states in their planning for policy, operational, and IT systems changes as they streamline non-Modified Adjusted Gross Income (MAGI) Medicaid renewal processes to align with those for MAGI Medicaid and CHIP.
CMS released an informational bulletin to provide updated information on the timing and expectations for states to achieve compliance with all federal Medicaid and CHIP renewal requirements. To accompany the informational bulletin, CMS also released a compliance template, which states should use to submit their compliance plans by December 31, 2024. Compliance plans will detail how states will achieve compliance with all applicable requirements no later than December 31, 2026.
CMS released an informational bulletin to provide updated information on the timing and expectations for all states to achieve compliance with all federal renewal requirements, including states that implemented CMS-approved mitigation strategies and those who have since identified areas of non-compliance with renewal requirements. All states are required to complete a compliance assessment, demonstrate compliance with federal Medicaid and CHIP renewal requirements, and submit a plan outlining steps and milestones for addressing identified areas of non-compliance to CMS by December 31, 2024. Compliance plans will detail how states will achieve compliance with all applicable requirements no later than December 31, 2026.
On August 29, 2024, the Centers for Medicare & Medicaid Services (CMS) released a CMCS Informational Bulletin (CIB) and accompanying slide deck to support states facing renewal backlogs. With this guidance, CMS is providing states additional time—until December 31, 2025—to complete Medicaid and CHIP eligibility renewals, address persistent backlogs in processing redeterminations, and achieve compliance with federal renewal timeliness requirements. This expert perspective provides an overview of the CIB.
This slide deck presents approaches that states can implement temporarily and on an ongoing basis to come into compliance with federal regulations on timely processing of Medicaid and CHIP eligibility renewals, including: options for processing renewals pending more than six months; time-limited strategies for renewal processing; and ongoing practices to support timely renewal processing.
CMS is providing states additional time to complete eligibility renewals, address persistent backlogs in processing redeterminations, and ensure that states achieve compliance with federal renewal timeliness requirements by December 2025. This informational bulletin outlines the duration and conditions under which states may rely on an exception to those requirements.
A new KFF report highlights findings from the 22nd annual survey of state Medicaid and CHIP programs officials conducted by KFF and the Georgetown University Center for Children and Families in March 2024. The report presents a snapshot of actions states have taken to improve systems, processes, and communications during the unwinding, as well as key state Medicaid eligibility, enrollment, and renewal policies and procedures in place as of May 2024. For example, nearly all state respondents are interested in maintaining 1902(e)(14) waiver flexibilities that have been most useful to streamlining renewal processes. States reported their top three successes during the unwinding included improved outreach and enrollee communication, enhanced stakeholder engagement, and increased ex parte rates.
CMS recently released an interim, preliminary overview of states’ scheduled timelines for completion of unwinding-related renewals as an update to prior estimates (CMS last provided an update on state unwinding timelines in June 2023). The document reflects preliminary estimates of states’ scheduled timelines to complete a first renewal for individuals who were enrolled in Medicaid or CHIP as of the beginning of the state’s unwinding period. The document also states that additional guidance related to renewal processing and an updated table with state timelines for completion of all unwinding-related renewals is forthcoming.
CMS approved Oregon’s Basic Health Program (BHP) Blueprint. Through the BHP, Oregon will be able to provide healthcare coverage to individuals with incomes between 138% to 200% of the federal poverty level. Individuals enrolled in the BHP will receive a comprehensive benefit package, including all essential health benefits, and will not be charged premiums or other cost-sharing.
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.
New Jersey Department of Banking and Insurance Acting Commissioner Justin Zimmerman announced the department will extend a previously announced special enrollment period (SEP) to make it easier for qualified individuals who are no longer eligible for NJ FamilyCare coverage to enroll with Get Covered New Jersey. The end date of the SEP will be extended from July 31, 2024, to November 30, 2024.
CMS announced the extension of the temporary special enrollment period (SEP) for individuals no longer eligible for Medicaid or CHIP to enroll in Marketplace coverage. The end date of the “Unwinding SEP” will be extended from July 31, 2024, to November 30, 2024.
On December 6, the Centers for Medicare & Medicaid Services published and made effective an interim final rule (IFR) with comment period regarding states’ ongoing unwinding efforts to redetermine eligibility for all Medicaid enrollees nationwide. This expert perspective summarizes the IFR, which interprets and implements the state reporting requirements and CMS enforcement authorities that Congress enacted last winter in the Consolidated Appropriations Act of 2023.
CMS published and made effective an interim final rule with comment period regarding states’ ongoing unwinding efforts to redetermine eligibility for all Medicaid enrollees.
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.
CMS published an interactive map and updated table of the section 1902(e)(14) waivers approved for states and territories to facilitate unwinding, including strategies to support ex parte processes.
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.
CMS published 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. In a press release, CMS announced that all 30 states and territories are required to pause procedural disenrollments for impacted people unless they can ensure all eligible people are not improperly disenrolled as a result of the systems issue.
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.
On August 30, 2023, the Centers for Medicare & Medicaid Services (CMS) issued a State Medicaid Director Letter (SMDL) instructing states to assess whether they are in compliance with federal Medicaid regulations that require all renewal processes be conducted at the individual level. This expert perspective summarizes the SMDL, which lays out immediate actions that states must take to determine if they are out of compliance with the federal renewal requirements and mitigate compliance issues.
On August 30, the Centers for Medicare & Medicaid Services (CMS) issued a State Medicaid Director Letter (SMDL) instructing states to assess whether they are in compliance with federal Medicaid regulations that require all renewal processes be conducted at the individual level. This expert perspective reviews the Federal Financial Participation match available to states as they work to come into compliance with the requirements of the SMDL.
CMS issued a State Medicaid Director Letter (SMDL) instructing states to assess whether they are in compliance with federal Medicaid regulations that require all renewal processes be conducted at the individual level.
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.
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.
CMS released frequently asked questions for state Medicaid and CHIP agencies on FMAP reduction and the failure to meet reporting requirements
HHS Secretary Becerra issued a letter to governors in response to early state data on Medicaid redetermination outcomes. The letter expresses concern related to high rates of disenrollments for procedural reasons as well as coverage loss among children, and encourages states to redouble efforts to (1) leverage additional, temporary flexibilities to support unwinding; and (2) partner with stakeholders to protect against inappropriate coverage loss.
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.
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.
Governor Gretchen Whitmer issued an executive directive instructing all state of Michigan departments to work together to help Michiganders keep Medicaid coverage or find affordable health insurance as Medicaid renewals begin. The executive directive instructs all state departments to assist the Department of Health and Human Services (DHHS) and the Department of Insurance and Financial Services (DIFS), by distributing information to Michiganders regarding the redetermination process and how to renew eligibility, and sharing necessary data to conduct outreach.
CMS released this frequently asked questions (FAQs) document regarding changes made to the Medicaid continuous enrollment condition under the Families First Coronavirus Response Act (FFCRA) by the Consolidated Appropriations Act 2023 (CAA, 2023). Key topics addressed in the FAQs include questions relating to the CAA, 2023 returned mail condition for states claiming the increased FMAP available under the FFCRA, reestablishment of premiums in Medicaid and CHIP, renewal requirements for individuals who receive Social Security Income, and Medicaid and CHIP agency capacity to share beneficiary data with enrolled providers to support renewals.
CMS has confirmed that the termination of the national emergency does not impact the planned May 11 termination of the public health emergency (PHE), any associated PHE unwinding plans, or any existing 1135 waivers.
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.
Frequently asked questions (FAQs) regarding implementation of the Families First Coronavirus Response Act (FFCRA), the Coronavirus Aid, Relief, and Economic Security Act (CARES Act), and the Health Insurance Portability and Accountability Act (HIPAA). These FAQs have been prepared jointly by the Departments of Labor (DOL), Health and Human Services (HHS), and the Treasury. These FAQs answer questions from stakeholders to help people understand the law and benefit from it, as intended.
This document provides a list of available guidance, tools, and resources that may be helpful to states as implement the CMS approved processes and procedures (mitigation strategies) needed to be considered compliant for the renewal provision of section 5131 of the Consolidated Appropriations Act, 2023. Resources are organized by renewal requirement.
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.
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.
CMS posted an FAQ that says issuers that reduce or eliminate agent and broker commissions for enrollments through special enrollment periods (SEPs) are violating the guaranteed issue provisions of the ACA and doing so would constitute a discriminatory marketing practice.
The state’s Office of Superintendent of Insurance recently notified its carriers that a broker compensation structure that pays differing commissions for open and special enrollments violates state nondiscrimination provisions and constitutes an unfair or deceptive practice under the state’s unfair trade practices statute.
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.
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