The 2021 Annual 50-State Survey on Medicaid and CHIP Eligibility and Enrollment conducted by the Kaiser Family Foundation (KFF) and CCF is now available. As in previous years, the report confirms eligibility levels for children, pregnant women, parents and expansion adults. However, in light of the ongoing COVID-19 pandemic, the survey was scaled back in length and scope and focuses on key state actions taken or planned in response to the pandemic. The key findings:

• In 2020, Nebraska became the 37^th state to implement the ACA Medicaid adult expansion. Otherwise, Medicaid and CHIP eligibility is largely unchanged due to the maintenance of effort provisions requiring states to maintain eligibility standards to qualify for the COVID-related 6.2 percentage point increase in federal match.
• Only one-third of states (17) reported an increase in applications in 2020. This may result from smaller than expected declines in employer-sponsored insurance, drops in applications due to office closures, and the MOE’s elimination of ‘reapplications’ associated with churn. Just over half of the states (28) reported a shift in the primary mode of application (online, telephone, in-person, mail), largely driven by an increase in online applications.
• Most states (41) are processing ex parte or automated renewals as of January 2021. Although states must maintain continuous coverage during the COVID-related public health emergency (PHE), two-thirds of the states (28 of 41) processing renewals are also sending renewal forms and requests for information when unable to renew coverage through electronic data sources.
• Just over one third of states (19) proactively take steps to update mailing addresses or plan to do so before resuming normal operations. Low-income families are more likely to experience unstable housing, a problem that has only worsened during the pandemic. Once the PHE expires and states resume normal operations, states may automatically terminate coverage if it has received returned mail for an enrollee. This could result in large numbers of enrollees who remain eligible losing coverage at the end of the PHE.

In CMS guidance issued in December, states were encouraged to resume normal operations to the greatest extent possible prior to the end of the PHE. But as states take steps to prepare, some are hoping for additional technical assistance and time to reduce backlogs, minimize disruptions in coverage, and avoid unevenly distributed workloads in the future.

As the Biden administration reviews the previous administration’s rulemaking and guidance on resuming normal Medicaid and CHIP eligibility and enrollment processes, it will be helpful to keep in mind additional steps that states should take to ensure that no eligible enrollee loses coverage at the end of PHE. Stay tuned for a future blog on ways to better achieve that goal.