Secretary Becerra Extends the PHE: What Does This Mean for Medicaid and the Continuous Enrollment Provision?

Earlier today, HHS Secretary Becerra renewed the COVID-related public health emergency (PHE). The latest extension will expire on April 16, 2022. By law, public health emergencies are declared in 90-day increments. The current PHE ends January 16, 2022, so a 90-day extension takes us to April 16, 2022. A PHE can be extended as many times as deemed necessary by the Secretary. It can be allowed to expire at the end of the 90-day period or terminated early if deemed appropriate. What do these three possible scenarios mean for Medicaid if Congress does not take additional action as proposed in the Build Back Better Act (BBB)?

  • PHE is allowed to expire on April 16, 2022. In this scenario, the 6.2 percentage point bump in the federal share of Medicaid would continue until the end of the quarter or June 30, 2022. However, the continuous enrollment requirement would end on April 30, 2022. This means states could begin processing renewals as of May 1, 2022 based on guidance issued by CMCS in December 2020 and revised in August 2021. States would be required to conduct a renewal, according to regulation, for everyone based on current circumstances before disenrolling anyone. Given that the Biden administration has promised to give a 60-day notice to states prior to the end of the PHE, if it hasn’t done so by February 15, 2022, one might expect that it would be extended again by April 16, 2022.
  • PHE is extended again before it expires on April 16, 2022. Under this scenario, the PHE would expire on July 15, 2022. The 6.2 percentage point bump in FMAP would continue until September 30, 2022, and states could restart renewals as of August 1, 2022.
  • PHE is terminated prior to April 16, 2022. While many think this scenario is highly unlikely, it is possible. However, the administration would need to provide notice soon. So, for example, if the PHE was terminated on March 31, 2022, the Biden administration would need to inform states by January 31, 2022 – two weeks from now. Once we pass that date, we can be certain that the PHE will not end before April 16, 2022 (assuming the administration keeps its promise).

However, we know Congress is considering delinking the FMAP bump and continuous enrollment and other maintenance of effort provisions from the PHE. The most recent draft of the BBB would have begun to phase out the enhanced FMAP in the second and third quarters of the year (April – September 2022) and, if it becomes law as written, states would be allowed to restart renewals as of April 1st.

The lack of certainty is weighing on states and Medicaid stakeholders. If BBB had been enacted in December, states would have had three months to get ready. And yet, many states have indicated they need more – not less – lead time. Even though Congress could still enact some version of the BBB provisions relating to the unwinding of the continuous enrollment requirement, some states would find an April 1, 2022 renewal start date challenging. Depending on when such legislation might be taken up, Congress will likely be pressured to push the unwinding out beyond April 1, 2022.

So where does this leave the continuous enrollment requirement? Without other action, states can start disenrolling people beginning May 1, 2022. At that time, they will be required to conduct a full renewal based on current circumstances before disenrolling anyone. Regardless of timing, the lifting of the continuous enrollment requirement will have a substantial impact on states and Medicaid enrollees, particularly in states that have been unable to renew coverage automatically for a significant portion of enrollees. Some have described this as the single largest enrollment event since the Affordable Care Act. In some states, it will be the most significant enrollment action in the 50+ year history of Medicaid.

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