Unwinding and Returning to Regular Operations after COVID-19

The expiration of the continuous enrollment condition 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 were required to maintain enrollment of nearly all Medicaid enrollees during the COVID-19 Public Health Emergency.

The Consolidated Appropriations Act, 2023, delinked the end of the FFCRA’s Medicaid continuous enrollment condition from the end of the COVID-19 Public Health Emergency. As a result, the Medicaid continuous enrollment condition will end on March 31, 2023. States will soon resume normal operations, including restarting full Medicaid and CHIP eligibility renewals and terminations of coverage for individuals who are no longer eligible. Beginning April 1, 2023, states are able to terminate Medicaid enrollment for individuals no longer eligible. States will have up to 12 months to return to normal eligibility and enrollment operations.

CMS will continue to update this page as additional tools and resources are released.

Guidance (SHOs, CIBs, and FAQs)

• End of the Medicaid Continuous Enrollment Condition Frequently Asked Questions for State Medicaid and CHIP Agencies (Posted 05/12/2023)
• Medicaid Continuous Enrollment Condition Changes, Conditions for Receiving the FFCRA Temporary FMAP Increase, Reporting Requirements, and Enforcement Provisions in the Consolidated Appropriations Act, 2023 (Posted 01/31/2023)
• 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)

Section 1902(e)(14)(A) Waiver Approvals

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

Data Reporting

• COVID-19 Continuous Enrollment Condition Data Reporting

Policy & Operational Resources

Renewals, Redeterminations, and Other Program Requirements

• Resources to Support State Implementation of Renewal Mitigation Strategies (Posted March 23,2023)
• 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)
• Ex Part Renewal: Strategies to Maximize Automation, Increase Renewal Rates, and Support Unwinding Efforts (Posted 10/20/2022)
• Preparing for the End of the COVID-19 Public Health Emergency: Opportunities to Support Medicaid and SNAP Unwinding Efforts (Posted 11/3/2022)
• Supporting Seamless Coverage Transitions for Children Moving Between Medicaid and CHIP in Separate CHIP States (Posted 12/12/2022)
• CIB: Medicaid and Children’s Health Insurance Program (CHIP) Renewal Requirements (Posted 12/4/2020)
• Opportunities to Support Unwinding Efforts for States with Integrated Eligibility Systems and/or Workforces (Posted 9/16/2022)
• 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 1/6/2023)
• Eligibility & Enrollment Processing for Medicaid, CHIP, and BHP During COVID-19 Public Health Emergency Unwinding Key Requirements for Compliance (Posted 5/17/2022)
• Strategic Approaches to Support State Fair Hearings as States Resume Normal Eligibility and Enrollment Operations After the COVID-19 PHE (Posted 4/4/2022)

Best Practices & Strategies to Support Specific Populations

• Medicaid and Children's Health Insurance Program (CHIP) Disability and Language Access Requirements Slide Deck (Posted 2/21/2023)
• Presentation: Strengthening Tribal and State Partnerships to Prepare for Unwinding (Posted 8/30/2022)
• Medicaid and CHIP Unwinding Planning Efforts: Summary of Best & Promising State Practices from CMS/State Discussions (Posted 4/4/2022)
• Connecting Kids to Coverage: State Outreach, Enrollment and Retention Strategies issue brief (Posted 11/24/2021)

Planning Tools & Templates

• Anticipated 2023 State Timelines for Initiating Unwinding-Related Renewals (Posted 2/24/2023)
• 60 Day Notice Timeline for States
• Letter to Governors on Unwinding (Posted 5/10/2022)
• 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)
• 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)
• Strategies States and U.S. Territories Can Adopt to Maintain Coverage of Eligible Individuals as they Return to Normal Operations (Posted 11/24/2021)
• Top 10 Fundamental Actions to Prepare for Unwinding and Resources to Support State Efforts (Posted 06/02/2022)
• 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

Systems Resources

• Systems Readiness Artifacts Refresher (Posted 1/6/2023)
• 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)

Communications Resources and Speaking Requests

• Unwinding Communications Resources and Speaking Requests 

Medicaid/Marketplace Coordination Resources

• State Based Exchange (SBE) Priority Metrics: Medicaid/Children’s Health Insurance Program (CHIP) Continuous Enrollment Condition Unwinding Overview and Template (Posted 5/26/2023)
• Medicaid Continuous Enrollment Condition Unwinding Marketplace Frequently Asked Questions (FAQ) Companion Resource (Posted 5/26/2023)
• Medicaid Continuous Enrollment Condition Unwinding Marketplace Frequently Asked Questions (FAQ) (Posted 5/18/2023)
• Overview of Federal Marketplace Assister Outreach and Consumer Engagement Strategies (05/18/2023)
• New Federal Marketplace Reminder Letter Templates – See “Loss of Medicaid/CHIP Reminder Letters” in English or Spanish (05/18/2023)
• Temporary Special Enrollment Period (SEP) for Consumers Losing Medicaid or the Children’s Health Insurance Program (CHIP) Coverage Due to Unwinding of the Medicaid Continuous Enrollment Condition – Frequently Asked Questions (FAQ) (Posted 01/31/2023)
• FFM Inbound Account Transfer Matching Functionality Slide Deck (Posted 10/25/2022)
• Strategies for SBMs to Improve Medicaid to Marketplace Coordination and Maximize Enrollee Transitions at the End of the Continuous Enrollment Requirement
• 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)
• CIB: Coordination of Eligibility and Enrollment between Medicaid, CHIP and the Federally Facilitated Marketplace (FFM or “Marketplace”) (Posted 7/25/2016)

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
• 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)

CMCS Medicaid and CHIP All State Calls

In March of 2020, CMCS launched a regular All State Call series to bring the latest information available to support states and territories as they respond to the COVID-19 public health emergency and prepare for unwinding of COVID-19 flexibilities.

• Slide decks, transcripts, and recordings from CMCS’ Medicaid and CHIP All State Calls

Partner Education on Medicaid and CHIP Continuous Enrollment Unwinding Webinars

HHS and CMS host a series of monthly webinars on Medicaid and CHIP Continuous Enrollment Unwinding to educate partners. Topics covered during the webinar vary each month. Webinars take place the fourth Wednesday of each month from 12:00 - 1:00pm ET.

• Slides and transcripts from the Partner Education Monthly Series
• Registration link