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

• 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 (PDF, 815.14 KB) (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 (PDF, 3.33 MB) - 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 (PDF, 248.18 KB) - Print Only Version for Viewing (Please note states should download the version linked above to complete and submit the report)
• Unwinding Data Report (XLSX, 70.96 KB)
  • Unwinding Data Specifications (PDF, 430.46 KB)

Tools and Templates

• Top 10 Fundamental Actions to Prepare for Unwinding and Resources to Support State Efforts (PDF, 289.58 KB) (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 (PDF, 1.75 MB))  (Spanish (PDF, 1.94 MB))
  • Medicaid Unwinding Toolkit Graphics (ZIP, 5.64 MB)
  • Graphics for Providers - Full Page (PDF, 217.87 KB) and Half Page (PDF, 152.82 KB)
  • 2022 Back-to-School Toolkit and graphics
• Consumer Research on Unwinding Phase I: Preventing Churn (PDF, 259.21 KB)
• Medicaid and CHIP Continuous Enrollment Unwinding Speaking Engagement Request Form

Other Guidance and Resources

• 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)
• Eligibility & Enrollment Processing for Medicaid, CHIP, and BHP During COVID-19 Public Health Emergency Unwinding Key Requirements for Compliance (PDF, 6.91 MB) (Posted 5/17/2022)
• Letter to Governors on Unwinding (PDF, 264.9 KB) (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 (PDF, 508.15 KB)
• Strategic Approaches to Support State Fair Hearings as States Resume Normal Eligibility and Enrollment Operations After the COVID-19 PHE (PDF, 324.91 KB) (Posted 4/4/2022)
• Medicaid and CHIP Unwinding Planning Efforts: Summary of Best & Promising State Practices from CMS/State Discussions (PDF, 1.47 MB) (Posted 4/4/2022)
• 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)
• 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)
• 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)
• 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 (PDF, 1.06 MB):  CMS Unwinding Resources
• March 15, 2022 All-State Call Presentation (PDF, 1.59 MB):  CMS Unwinding Resources
• March 8, 2022 All-State Call Presentation (PDF, 1.71 MB):  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 (PDF, 694.28 KB)