Mar, 31, 2023

States of Unwinding

In this new expert perspective series, State Health and Value Strategies will highlight examples of the work states are engaging in to prepare for and operationalize the unwinding of the continuous coverage requirement to minimize coverage losses. States are on different timelines for initiating Medicaid eligibility redeterminations following the end of the continuous coverage requirement on March 31, 2023 and therefore in different stages of the process. This new series aims to showcase strategies that other states may be interested in adopting and highlight how states are leveraging federal flexibilities. As a reminder, SHVS has created a one-stop resource page to support states as they plan for and implement unwinding. 

Communicating About Unwinding

As the majority of states focus on their outreach to enrollees, states are ramping up their communications efforts and messaging campaigns. The following are examples of how states are working to communicate with enrollees and other stakeholders.

Alaska has created a webpage dedicated to informing enrollees about unwinding. The webpage, created by the Division of Public Assistance, features SHVS’ Continuous Coverage Unwinding: Enrollee Outreach Video, customized for Alaska. Several versions of the enrollee outreach video are also featured under training videos for the Department of Health and the Department of Family and Community Services. As a reminder, states may customize the end card of each video by contacting Laura Buddenbaum at to connect with our communications technical assistance partners providing customizations.

Colorado announced it is in compliance with federal requirements to claim the enhanced FMAP. Executive Director Kim Bimestefer of the Colorado Department of Health Care Policy & Financing (HCPF) issued a message to stakeholders on the end of the Medicaid continuous coverage requirement, describing the state’s compliance with CMS’ criteria for obtaining enhanced federal matching funds. The state also announced it began sending text message reminders to Medicaid members who need to complete renewal paperwork to see if they still qualify for health coverage.

The District of Columbia launched a campaign to encourage enrollees to update their contact information. The Department of Health Care Finance (DHCF), the District of Columbia’s state Medicaid agency, announced the start of a public awareness campaign to update enrollee contact information and renew their health coverage. The campaign will include grassroots outreach through neighborhood and citywide events; regular virtual meetings hosted by DHCF on Medicaid renewal; an advertising campaign that touches every Ward in the District that directs enrollees on steps to renew; and a “Stakeholder Communications Toolkit” to assist outreach from community-based organizations, government agencies, and other stakeholders who support and provide services to Medicaid enrollees.

Illinois is implementing a multi-platform outreach campaign. The Pritzker administration is launching an all-out public awareness initiative to ensure Illinoisans retain their health insurance coverage when Medicaid eligibility verifications resume. The Department of Healthcare and Family Services’ public effort, coined “Ready to Renew,” is a multi-platform outreach campaign that includes paid advertisements, print, digital and broadcast communication, and grassroots outreach to help Medicaid enrollees ensure they are ready for required upcoming coverage renewals.

Maine published a communications toolkit for partners. The Maine Department of Health and Human Services published a communications toolkit for community-based organizations, partners, providers, and other stakeholders to inform MaineCare (Medicaid) enrollees about the upcoming renewal process. The toolkit, along with Maine’s unwinding webpage, provides important resources to help inform people with MaineCare about the steps they need to take to avoid losing coverage.

Rhode Island is funding community organizations to reach enrollees. The state is working with community partners and advocates to conduct outreach efforts ahead of eligibility redeterminations. The state is also offering mini grants to community partners to reach those most at risk of losing coverage during the renewal process. Rhode Island also created a new webpage to inform Medicaid enrollees about the continuous coverage unwinding. The page features the SHVS Continuous Coverage Unwinding: Enrollee Outreach Video, customized for Rhode Island.

Leveraging Federal Flexibilities and Improving Processes

As states begin eligibility redeterminations, some states are implementing processes to reduce the administrative burden on enrollees to minimize the loss of coverage. Other states are leveraging federal flexibilities to improve the efficiency of their eligibility and enrollment process or deploying strategies to address particular populations of concern.

California is suspending asset tests for non-MAGI populations. The Department of Health Care Services announced that it submitted a section 1902(e)(14) waiver request to renew eligibility for non-Modified Adjusted Gross Income (non-MAGI) populations without requesting additional information and to disregard increases in assets since the last Medi-Cal (Medicaid) determination. This waiver—which will be effective retroactive to March 1, 2023 through December 31, 2023—will increase the number of non-MAGI-based individuals who will have their coverage renewed during unwinding. California is planning to eliminate the asset limit entirely on January 1, 2024.

Kansas’ enrollees can now update information online. KanCare has updated its website to make it easier for people enrolled in Medicaid to update their contact information and complete the verification process.

Rhode Island expects to use ex parte to renew eligibility for half of its enrollees. Governor Dan McKee announced that the state expects about half of Medicaid renewals to be passive and require no action from the enrollee. Those who cannot be passively renewed will be broken down into monthly renewals beginning April 1, with the last group of renewals beginning in March 2024. Rhode Island will also delay the redetermination of families with children: families with children will not start their Medicaid renewal process until December.