New CMS Resource is a Helpful Summary of Requirements for Unwinding the Continuous Coverage Protection

Over the past year and a half, CMS has released a variety of guidance, slide decks, tools, templates, and other resources on the unwinding of the continuous coverage provision. After a while, it can be pretty daunting to keep up with everything. Thankfully, the agency made it easier to find these resources by posting all related documents on a single web page.

Now the agency has upped its game by creating a very helpful summary of rules, flexibilities, and recommendations to states on how they should approach the unwinding of the continuous coverage provision. If you want one go-to document with all the relevant details, this is the one. It includes information about:

  • Renewals
  • Acting on Changes in Circumstances
  • Application Processing
  • Verifying Eligibility at Application
  • Coordination with the Marketplace
  • Notice Requirements
  • Fair Hearings, Reviews, and Appeals
  • State Administration & Oversight
  • CMS Monitoring & Enforcement
  • Temporary Flexibilities during the Unwinding Period

The agency did a great job of describing all the weedy content in a clear way that those without deep knowledge of eligibility and enrollment can understand. It includes nuances that add details about options for states. For example, on slide 10, it clearly stipulates that enrollees must be able to return the signed renewal form through all submission modes: mail, in-person, online, or phone. But then it indicates that states may encourage individuals to use a specific modality, provided that all options remain available. And there’s something for the lawyers among us, with references to the relevant regulations on each page without bogging down the text with citations.

The document lays out monitoring and enforcement specifically. Slide 51 focuses on the tools that CMS will use to monitor state Medicaid eligibility operations on an ongoing basis, including monitoring enrollment and terminations using monthly Performance Indicator and T-MSIS data, examining state expenditures, and through periodic and ongoing calls with states. During the unwinding, states will also have to submit state renewal distribution reports which summarize their plans to distribute renewals and avoid inappropriate coverage loss, as well as baseline and monthly unwinding eligibility and enrollment data reports. Now if we could get the agency to post all of these data publicly and promptly, I’d be a happy camper.

In terms of enforcement, the agency notes that it will closely monitor disenrollment data to identify potential violations of federal requirements resulting in inappropriate terminations. When violations are identified, CMS will first work with the state to address the violation, provide technical assistance, and discuss correction options. But slide 53 notes that states experiencing issues with high volumes of terminations or other possible violations will be asked to submit their more comprehensive operational plans for review. States will be required to develop mitigation plans to reduce adverse actions but if violations are not corrected or addressed through technical assistance and mitigation plans, CMS will initiate compliance action, beginning with a corrective action plan (CAP) and more intensive monitoring. The document reaffirms that CMS has the authority to withhold federal matching funds in cases where an action is deemed to be in violation with certain statutory requirements. Let’s hope it won’t come to that but it will be important for the agency to be prepared to respond rapidly to problems so that millions of children and low-income families do not inappropriately lose their health coverage.