CMS Releases Key Information on Unwinding the Medicaid Continuous Coverage Requirement

CMCS has released a timely informational bulletin (CIB) with details about the implementation of the unwinding provisions enacted by Congress just before the end of the year. As previously described in this blog, the 2023 Consolidated Appropriations Act (CAA) ends the Medicaid continuous coverage protection as of March 31, 2023. While the CAA does not end the COVID-19 Public Health Emergency (PHE), it does delink the continuous enrollment requirement from the end of PHE. It also establishes data reporting requirements and new conditions that states must meet in order to continue to receive enhanced federal Medicaid funding that has been extended in a phased-down manner through all of 2023.

Beginning April 1, states may resume disenrollment of people who are no longer eligible for Medicaid, but only after the state has conducted a fresh and complete renewal including examining eligibility for all categories of Medicaid. The CIB reaffirms that states have 12 months to initiate renewals and an additional two months to complete processing. It also provides helpful timeline charts that show how states may stagger the start of the unwinding process. When states plan to begin the unwinding determines the timeline for submitting the state’s renewal plan and baseline unwinding data as required by CMS. For example, states may initiate their first batch of renewals as early as February, or they may do so in March or April.

In addition to the state’s renewal plan and baseline unwinding data, states must provide information about their eligibility system’s readiness, including its testing plan and test results. The renewal plan and system readiness must be submitted by February 1 for states that intend to initiate the first renewals in February, and February 15 for all other states. The baseline data report is due on the 8th of the month in which the state first initiates renewals. Thereafter, monthly data reports are due on the 8th of the month for the prior month.

States will continue to receive the 6.2 percentage point bump in federal Medicaid funding (4.34 percentage points in CHIP) during the first quarter of 2023. Thereafter, the FMAP increase phases down each quarter before it ends December 31, 2023.

Starting April 1, 2023, states will need to meet new maintenance of effort (MOE) requirements. The CIB clearly states that certain MOE carry over from the Families First Coronavirus Act, although the continuous coverage requirement is lifted as of March 31, 2023. (To be eligible for the phased-down FMAP increases during the period they are available, states continue to be subject to the original requirements that they may not make their Medicaid eligibility standards, methodologies and procedures more restrictive or raise premiums.) The new MOE provisions require states to 1) conduct renewals in accordance with federal requirements; 2) make an attempt to maintain up-to-date mailing addresses using the USPS National Change of Address database, other public programs, OR other reliable sources, including mailing addresses, phone number, and email address; and 3) attempt to contact enrollees, via more than one communication mode, prior to disenrollment on the basis of returned mail. The CIB indicates there will be additional guidance forthcoming on these provisions.

The CIB acknowledges that the CAA established a separate provision that requires all states to report specific unwinding data. While this requirement is not a condition of the phased-down FMAP starting April 1, states that fail to report the data may be subject to a reduction in FMAP. Additional guidance is also expected on these provisions.

[For more information on Medicaid and CHIP provisions included in the Consolidated Appropriations Act, see CCF’s brief.]

Tricia Brooks is a Research Professor at the Center for Children and Families (CCF), part of the McCourt School of Public Policy at Georgetown University.