A year into unwinding, roughly half of all individuals enrolled in Medicaid or the Children’s Health Insurance Program at the start of unwinding have been redetermined. Some states are extending their timelines for unwinding and to outreach to enrollees yet to be redetermined, states are funding community based organizations to engage specific populations, such as postpartum individuals and their children. States continue to refine their communication and outreach strategies and surveying individuals disenrolled from Medicaid to better understand the barriers to renewal. This States of Unwinding post features updates from California, Colorado, Connecticut, Georgia, Hawaii, Maine, Oregon, Rhode Island, Tennessee, Virginia and Washington. 

Following the release on December 18, 2023 by the Centers for Medicare & Medicaid Services of a suite of Medicaid unwinding-related guidance and resources focused on ensuring eligible children maintain coverage, several states announced additional efforts to preserve coverage for children. States continue to address the reinstatement of individuals whose coverage was terminated as the result of a household ex parte review, partner with community organizations to support renewals and evaluate unwinding. This States of Unwinding post features updates from Arizona, Georgia, Kentucky, Maryland, Michigan, Nebraska, Nevada, New Hamphsire, New Jersey, New York, North Carolina, Oregon, Pennsylvania and Rhode Island. 

As states continue to implement systems changes to enable ex parte reviews at the individual level, they are pausing procedural terminations, announcing reinstatements of coverage for affected individuals and publishing mitigation strategies being implemented to facilitate individual level ex parte reviews. States also continue to make use of federal flexibilities to streamline unwinding eligibility and enrollment processes, including receiving approval from CMS to continue coverage for individuals while they appeal decisions related to their eligibility and benefits. Recent Medicaid outreach and communications efforts have been focused on children, with states releasing communications materials for school partners, or reminding parents that their children may still be eligible. State-Based Marketplace communication efforts include developing specific materials for this open enrollment period. This States of Unwinding post features updates from Alaska, California, Colorado, the District of Columbia, Idaho, Kentucky, Lousiana, Maryland, Massachusetts, Minnesota, Nebraska and Oregon.

State Health and Value Strategies

In the first half of October, additional states paused procedural terminations and reinstated coverage as they implemented mitigation strategies to address the system issues related to conducting ex parte at the individual level. In an effort to ensure eligible individuals maintain their coverage, several states are leveraging federal flexibilities to extend the amount of time Medicaid enrollees have to return renewal forms. Other states have implemented federal flexibilities to streamline the application process. States continue to outreach and communicate to enrollees about the unwinding, including alerting consumers about scams. As unwinding progresses, states continue to update their data dashboards and make information about unwinding public. This States of Unwinding post features updates from Alaska, Arizona, Arkansas, California, Colorado, Kentucky, Lousiana, Maine, Minnesota, Nebraska, New Mexico, New York, Oregon, Pennsylvania, Rhode Island, South Carolina, Texas, Washington and Wyoming. 

State Health and Value Strategies

As states look to address the system issues related to conducting ex parte at the individual level they are pausing procedural terminations and reinstating coverage for affected individuals, while also leveraging federal flexibilities to reduce the number of individuals terminated for procedural reasons. States continue to innovate in their efforts to outreach to and communicate with enrollees, capitalizing on back-to-school and partnering with community-based organizations to connect consumers with assistance. Medicaid communication and outreach efforts also include hosting webinars and virtual stakeholder meetings, while state Marketplaces are making outbound calls to individuals no longer eligible for Medicaid, hosting enrollment fairs and reminding consumers about their state’s special enrollment period. This States of Unwinding post features updates from Arizona, California, Colorado, Connecticut, Georgia, Idaho, Indiana, Kentucky, Maine, Maryland, Massachusetts, Michigan, Nevada, New Hampshire, New York, Vermont and Wisconsin. 

State Health and Value Strategies

With the start of the school year, states are leveraging back to school as an opportunity to encourage parents to return renewal forms. States are also supporting individuals in applying for coverage by connecting them with assisters who can help navigate the application process. States continue to leverage federal flexibilities to preserve coverage in light of high rates of procedural denials and Medicaid agencies continue to communicate and outreach to enrollees through a variety of modes. This States of Unwinding post features updates from Alabama, Arizona, California, Hawaii, Illinois, Kentucky, Maine, Michigan, New Mexico, Virginia and Wyoming. 

State Health and Value Strategies

As unwinding progresses, states are trying out different communication and outreach tactics. Additional states are leveraging federal flexibilities and taking advantage of new strategies announced by the Centers for Medicaid & Medicare Services (CMS) in June, 2023 to prevent procedural terminations. Minnesota and Vermont will take-up the flexibility announced by CMS to delay procedural terminations for enrollees by a month, while Michigan plans to take advantage of this strategy through June, 2024. States are also taking steps to make information about the unwinding public. Following the publication by CMS of state mitigation strategies, D.C. shared information about the strategies it has adopted to reach compliance with federal renewal requirements. This States of Unwinding post features updates from Colorado, the District of Columbia, Indiana, Massachusetts, Michigan, Minnesota, New York, Pennsylvania and Vermont. 

State Health and Value Strategies

An increasing number of states are publishing data on the progress of unwinding. States are using the publication of unwinding data as an opportunity to explain how unwinding is proceeding in their state. State Medicaid agencies remain focused on communicating to enrollees and conducting outreach to alert members of the need to return their renewal forms. Finally, as states finalized their budgets for the fiscal year that started July 1, two states allocated additional funding for unwinding. This States of Unwinding post features updates from Arizona, Arkansas, the District of Columbia, Georgia, Hawaii, Idaho, Indiana, Maryland, Michigan, Minnesota, Mississippi, New Jersey, New York, Oregon and Wisconsin. 

State Health and Value Strategies

With the exception of Oregon, all states have begun terminating enrollees no longer eligible for coverage and the unwinding of the Medicaid continuous coverage requirement is now being operationalized across the United States. As a result, communications and outreach is a key focus across the 49 states, with states who have been processing renewals since April adding new features to their outreach strategies. States that operate their own Marketplaces are ramping up their communications efforts as well and providing information and resources for employers. As more states have begun processing redeterminations they are also publishing data, with two states announcing the number of individuals no longer eligible for Medicaid who enrolled in coverage through the Marketplace. This States of Unwinding post features updates from Arizona, Colorado, Connecticut, Idaho, Massachusetts, Minnesota, Nevada, New York, Oklahoma, Pennsylvania, Rhode Island, Texas, Vermont, Washington and West Virginia. 

State Health and Value Strategies

With so much focus on the number of enrollees losing coverage, more states are making their data public and sharing information about the unwinding process–Kansas published call center data for the month of May and Texas posted its operational plan for unwinding. States also remain focused on communication and outreach and continue to partner with other stakeholders to communicate about unwinding, with South Carolina asking providers to encourage enrollees to return their renewal forms. Following the announcement last week of new strategies states can employ to minimize the loss of coverage for procedural reasons, Michigan announced it was leveraging the new federal flexibilities. This States of Unwinding post features updates from Arizona, Kansas, Kentucky, Maryland, Michigan, Minnesota, Mississippi, New Jersey, New York, South Carolina, Texas and Wisconsin. 

To highlight the end of the continuous coverage requirement, two states are deploying their governors as messengers to explain the unwinding. States continue to partner with other stakeholders to outreach to enrollees and create messaging toolkits for partners. As individuals losing Medicaid transition to the Marketplace, Louisiana has created a tool to help former Medicaid enrollees locate a broker and Maine has created a guide to help consumers navigate the state’s Marketplace. Also, states continue to publish data on the number of individuals terminated from coverage as well as those whose coverage was renewed. Massachusetts announced it will be publishing reports detailing Marketplace enrollment over the course of the unwinding. This States of Unwinding post features updates from Arizona, Arkansas, Colorado, Idaho, Louisiana, Maine, Maryland, Massachusetts, New Mexico, North Dakota, Pennsylvania and South Carolina.

As more states are beginning the redetermination and termination process, communication and outreach remains a key focus for states as they seek to get the word out to enrollees about the importance of returning renewal forms. States continue to coordinate their outreach efforts across agencies and partner with other stakeholders to reach enrollees. Some states are helping enrollees with completing their renewal paperwork by hosting in-person events and creating how-to videos and one state is offering enrollees financial incentives for completing their renewal. This States of Unwinding post features updates from Arizona, California, Colorado, Connecticut, the District of Columbia, Kentucky, Maryland, Massachusetts, Michigan, Minnesota, Missouri, New Hampshire, New Mexico, Oklahoma, Oregon, Pennsylvania and Texas. As a reminder, SHVS has created a one-stop resource page to support states as they plan for and implement unwinding.  

States continue to focus their efforts on outreach and communications, with several states adopting a collaborative approach to disseminating information about unwinding. States are co-branding communications materials across Medicaid and the Marketplace and some states are working with other stakeholders, such as managed care plans and community-based organizations, to reach out to enrollees. This States of Unwinding post features updates from Alaska, Arkansas, California, Colorado, the District of Columbia, Delaware, Illinois, Kentucky, Massachusetts, Maryland, Maine, Michigan, Minnesota, New Jersey, New Mexico, New York, Pennsylvania, Rhode Island, Vermont, Virginia and Washington.

As of May 1, an additional 14 states will begin terminating individuals determined ineligible for Medicaid. To prepare Medicaid enrollees for this upcoming deadline, Medicaid agencies and state Marketplaces are doubling down on their outreach and communication efforts. As unwinding progresses, more states are putting out press releases warning enrollees about scams. Beyond communications and outreach, states are also implementing safeguards for individuals who missed the window to sign up for Medicare Supplement policies. This States of Unwinding post features updates from Arizona, Colorado, the District of Columbia, Georgia, Idaho, Indiana, Kansas, Louisiana, Massachusetts, Maine, Michigan, Minnesota, Nebraska, New Mexico, Nevada, New York, Oregon, Pennsylvania, Rhode Island, South Carolina, Virginia, Washington and Wyoming.

This second post in the States of Unwinding series highlights the work states are engaged in to operationalize unwinding following the expiration of the Medicaid continuous coverage requirement as of March 31. While states continue to focus on outreach and communication efforts, they are also working on coordinating with their State-Based Marketplaces, investing additional resources to increase their workforce and leveraging federal flexibilities. This States of Unwinding features updates from Arizona, California, Connecticut, Idaho, Louisiana, Massachusetts, Minnesota, Montana, Nevada, New York and Texas.

This first post in the States of Unwinding series highlights the work states are doing to prepare for the end of the continuous coverage requirement on March 31, 2023. Leading up to the expiration date, states are focused on communication and outreach efforts and also leveraging federal flexibilities to improve processes in preparation for conducting renewals. This States of Unwinding features updates from Alaska, California, Colorado, the District of Columbia, Illinois, Kansas, Maine and Rhode Island.