Unwinding and Returning to Regular Operations after COVID-19

The expiration of the continuous coverage requirement authorized by the Families First Coronavirus Response Act (FFCRA) presents the single largest health coverage transition event since the first open enrollment period of the Affordable Care Act. As a condition of receiving a temporary 6.2 percentage point Federal Medical Assistance Percentage (FMAP) increase under the FFCRA, states have been required to maintain enrollment of nearly all Medicaid enrollees. When the continuous coverage requirement expires, states will have up to 12 months to return to normal eligibility and enrollment operations. 

Additionally, many other temporary authorities adopted by states during the COVID-19 public health emergency (PHE), including Section 1135 waivers and disaster relief state plan amendments (SPAs), will expire at the end of the PHE, and states will need to plan for a return to regular operations across their programs. CMS will continue to update this page as additional tools and resources are released. 

Unwinding Guidance

• Medicaid Continuous Enrollment Requirement Provisions in the Consolidated Appropriations Act, 2023 (Posted 01/05/2023)
• COVID-19 Public Health Emergency Unwinding Frequently Asked Questions for State Medicaid and CHIP Agencies (Posted 10/17/2022)
• Ending Coverage in the Optional COVID-19 Group: Preparing States for the End of the Public Health Emergency (Posted 10/17/2022)
• Promoting Continuity of Coverage and Distributing Eligibility and Enrollment Workload in Medicaid, the Children’s Health Insurance Program (CHIP), and Basic Health Program (BHP) Upon Conclusion of the COVID-19 Public Health Emergency (Posted 3/3/2022)
• 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 (Posted 8/13/2021)

• State Health Office Letter: 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 (Posted 12/22/2020)

• COVID-19 PHE Unwinding Section 1902(e)(14)(A) Waiver Approvals

State Reporting

• State Renewal Report - Version for State Submission (Please note that if you are using a Google Chrome or Microsoft Edge browser you must download the PDF for it to open)
  • State Renewal Report - Print Only Version for Viewing (Please note states should download the version linked above to complete and submit the report)
• Unwinding Data Report
  • Unwinding Data Specifications

Tools and Templates

• Improving Efficiency and Beneficiary/Staff Experience Through Improved Renewal Automation For Unwinding (Posted 12/02/2022)
• Resources to Support System and Logic Testing for Unwinding (Posted 09/30/2022)
• Top 10 Fundamental Actions to Prepare for Unwinding and Resources to Support State Efforts (Posted 06/02/2022)
• Medicaid and Children’s Health Insurance Program COVID-19 Health Emergency Eligibility and Enrollment Pending Actions Resolution Planning Tool (Posted 1/15/2021 and updated 3/3/2022)
• General Transition Planning Tool for Restoring Regular Medicaid and Children’s Health Insurance Program Operations after Conclusion of the Coronavirus Disease 2019 Public Health Emergency (Posted 1/15/2021)
• Program Integrity Considerations for Restoring State Medicaid and Children’s Health Insurance Program Operations Upon Conclusion of the COVID-19 Public Health Emergency
  • Risk Assessment Template - Word Version
  • Risk Assessment Template - Excel Version
  • Risk Assessment Tool Webinar

Communications Tools and Speaking Requests

• Medicaid and CHIP Continuous Enrollment Unwinding – Toolkit
  • English 
  • Spanish
  • Chinese
  • Hindi
  • Korean
  • Tagalog
  • Vietnamese
• Medicaid and CHIP Continuous Enrollment Unwinding Toolkit  Materials
  • Medicaid Unwinding Toolkit Supporting Materials (Available in English, Spanish, Chinese, Hindi, Korean, Tagalog, and Vietnamese)
  • Graphics for Providers - Full Page and Half Page
  • 2022 Back-to-School Toolkit and graphics
• Consumer Research on Unwinding Phase I: Preventing Churn
• Consumer Research to Inform Unwinding Outreach: Messaging to Promote the Use of HealthCare.gov
• Medicaid and CHIP Continuous Enrollment Unwinding Speaking Engagement Request Form

Other Guidance and Resources

• Systems Readiness Artifacts Refresher (Posted 1/6/2023)
• Supporting Seamless Coverage Transitions for Children Moving Between Medicaid and CHIP in Separate CHIP States (Posted 12/12/2022)
• 60 Day Notice Timeline for States (Posted 11/18/2022)
• Preparing for the End of the COVID-19 Public Health Emergency: Opportunities to Support Medicaid and SNAP Unwinding Efforts (Posted 11/3/2022)
• FFM Inbound Account Transfer Matching Functionality Slide Deck (Posted 10/25/2022)
• Ex Parte Renewal: Strategies to Maximize Automation, Increase Renewal Rates, and Support Unwinding Efforts (Posted 10/20/2022)
• Opportunities to Support Unwinding Efforts for States with Integrated Eligibility Systems and/or Workforces (Posted 9/16/2022)
• Presentation: Strengthening Tribal and State Partnerships to Prepare for Unwinding (Posted 8/30/2022)
• Eligibility & Enrollment Processing for Medicaid, CHIP, and BHP During COVID-19 Public Health Emergency Unwinding Key Requirements for Compliance (Posted 5/17/2022)
• Letter to Governors on Unwinding (Posted 5/10/2022)
• Medicaid and CHIP Learning Collaborative Webinar: Medicaid and Children’s Health Insurance Program (CHIP) Eligibility and Enrollment Unwinding Data Reporting & Submission (Posted 4/28/2022)
  • Slide Deck
• Strategic Approaches to Support State Fair Hearings as States Resume Normal Eligibility and Enrollment Operations After the COVID-19 PHE (Posted 4/4/2022)
• Medicaid and CHIP Unwinding Planning Efforts: Summary of Best & Promising State Practices from CMS/State Discussions (Posted 4/4/2022)
• Overview of Strategic Approach to Engaging Managed Care Plans to Maximize Continuity of Coverage as States Resume Normal Eligibility and Enrollment Operations (Posted 12/8/2021 and updated 3/3/2022 and 1/6/2023)
• Strategies States and U.S. Territories Can Adopt to Maintain Coverage of Eligible Individuals as they Return to Normal Operations (Posted 11/24/2021)
• Connecting Kids to Coverage: State Outreach, Enrollment and Retention Strategies issue brief (Posted 11/24/2021)
• Ensuring Continuity of Coverage and Preventing Inappropriate Terminations – Part 2 (Posted August 2021)
• Ensuring Continuity of Coverage and Preventing Inappropriate Terminations – Part 1 (Posted July 2021)
• CIB: Medicaid and Children’s Health Insurance Program (CHIP) Renewal Requirements (Posted 12/4/2020)

Medicaid/Marketplace Coordination

State Technical Resource Guide for FFM Assessment & Determination States

• Overview: State Medicaid/CHIP Agencies Accepting Federally-facilitated Marketplace Eligibility Decisions
• Operational Implementation: State Medicaid/CHIP Agencies Accepting Federally-facilitated Marketplace (FFM) Eligibility Decisions
• Additional Resources:
  • Outbound Account Transfer (AT): Identifying Eligibility Referral Reason and Verification Status
    • Supplemental Materials - OB AT – Identifying Elig. Referral Reason & Verification Status (Zip file)
  • Outbound Account Transfer Scenarios for States, Overview
  • Outbound Account Transfer Scenarios for States, Sample Payloads (Zip file)
• Addressing Medicaid and CHIP Procedural Terminations in States that Operate a State-Based Marketplace with Account Transfers (PDF, 448.22 KB) (Posted 6/30/2022)
• Strategies for SBMs to Improve Medicaid to Marketplace Coordination and Maximize Enrollee Transitions at the End of the Continuous Enrollment Requirement (PDF, 646.74 KB)
• CIB: Coordination of Eligibility and Enrollment between Medicaid, CHIP and the Federally Facilitated Marketplace (FFM or “Marketplace”) (Posted 7/25/2016)

CMCS Medicaid and CHIP All State Calls

• March 22, 2022 All-State Call Presentation:  CMS Unwinding Resources
• March 15, 2022 All-State Call Presentation:  CMS Unwinding Resources
• March 8, 2022 All-State Call Presentation:  CMS Unwinding Resources
• February 22, 2022 All-State Call Presentation: CMS Office of Communications consumer research on preventing churn during unwinding
• February 15, 2022 All-State Call Presentation: Sunsetting Medicaid and CHIP disaster relief SPAs and section 1135 waivers and options for disaster relief SPA provisions
• November 30, 2021 All-State Call Presentation: Strategies for retaining eligible individuals and engaging managed care plans
• August 19, 2021 All-State Call Presentation: Overview of August 2021 State Health Official Letter
• January 19, 2021 All-State Call Presentation: Overview of eligibility and enrollment provisions in December 2020 State Health Official Letter
• January 7, 2021 All-State Call Presentation: Overview of December 2020 State Health Official Letter
• June 16, 2020 All-State Call Presentation: Additional information on federal requirements for retaining Medicaid state plan flexibilities

• Wednesday, May 25, 2022- Preparing for the End of the COVID-19 Public Health Emergency: What Partners Need to Know About Medicaid and CHIP Coverage Webinar