Unwinding Wednesday #11: No 60-day Notice on the Unwinding; PHE Expected to Be Extended Until April 2023

In mid-October, Secretary Becerra extended the COVID-19 public health emergency (PHE) until January 11, 2023. It was the 11th 90-day extension since the PHE was first declared in January 2020. If this were to be the last extension HHS Secretary Becerra would have given states and stakeholders a 60-day advance notice earlier this week, as promised. So, what does this mean for the unwinding of the Medicaid continuous coverage protection?

Since no advance notice was given, we would expect the Secretary to extend the PHE again in January, pushing the end date out to April 11, 2023. Under this scenario, the continuous coverage provision would lift on April 30, 2023, but the enhanced federal match would continue until June 30, 2023. States could initiate the first batch of unwinding renewals in March, April, or May 2023, although no one could be disenrolled until May 1st  regardless of which month the state chooses to begin.

While it feels a bit like Groundhog Day every time we close in on the 60-day notice, the extension once again gives states and stakeholders more time to continue preparing for the eventual lifting of the continuous coverage protection. It also provides an opportunity for Congress to potentially take action to delink the continuous coverage requirement from the PHE on a date certain.

Also, if states are willing to forgo the enhanced federal Medicaid funding, they are not obligated to maintain the maintenance of effort (MOE) provisions, including the continuous coverage protection. However, based on an analysis by the Kaiser Family Foundation, federal fiscal relief to the states through September 2022 was more than double the cost of maintaining coverage for MOE enrollees, including the continuous coverage protection. While there have been rumors of this from time to time, as of yet no state has done so. But even if a state chooses this action, they will still need to follow the rules and requirements specified by CMS – including conducting fresh reviews of eligibility based on current circumstances.

So once again, we begin the waiting game. If Congress were to take action it would likely occur before the end of the year. If Congress doesn’t take action and the Secretary extends the PHE in January as expected, we’ll be waiting until February 10, 2023 to see what happens next.