Unwinding Medicaid Continuous Coverage Frequently Asked Questions

Congress’ funding agreement at the end of last year is expected to have a significant impact on millions of people who rely on Medicaid coverage and healthcare providers who receive reimbursement from Medicaid. Below are answers to frequently asked questions to help providers navigate the unwinding of Medicaid continuous coverage.

What is the Medicaid continuous coverage requirement?
Congress enacted a law when the pandemic began in 2020 that gave states additional Medicaid funding to keep people enrolled in Medicaid coverage during the COVID-19 public health emergency (PHE). The requirement was originally linked to the PHE and was set to end the month after it expired. However, an omnibus spending bill enacted in December 2022 severs this link and instead sets March 31, 2023 as the end of the requirement, regardless of whether the PHE remains in effect.1

How and when will the unwinding take place?
States will resume annual Medicaid eligibility reviews to “unwind” the continuous coverage requirement. Right now, people remain eligible for Medicaid even if they have a change in their income or family size, unless they voluntarily disenroll, move out of the state, or die.2 States have 12 months to initiate eligibility reviews of all their enrollees and can start reviews in February, March, or April. They can begin terminating coverage for people they determine are no longer eligible starting April 1. Each state is determining its own timeline, and most will spread their work over 12 months.3

Who is at risk of losing Medicaid? 
According to the Kaiser Family Foundation, when continuous enrollment ends, an estimated 5 to 14 million people could lose their current Medicaid or CHIP coverage during a 12-month unwinding period.2 Many people who have Medicaid are not aware their future eligibility could be at risk. Data from a June 2022 survey, conducted by the Urban Institute, showed that 62 percent of adults with family Medicaid enrollment were not aware of redeterminations after the continuous enrollment period ends.4

What challenges do enrollees face? 
People often lose their coverage at the point of renewal, even when they remain eligible, due to burdensome processes and paperwork. The large number of cases that will need to be renewed puts many people at risk of losing coverage.2 Enrollees might not know they need to complete a renewal, be confused by the process, not be eligible for Medicaid or not know they can get coverage through the Affordable Care Act marketplace.5

How can you help keep people covered?  
The Medicaid renewal process can be complicated. People may need help completing the renewal form and submitting the correct documents. Some enrollees who are no longer eligible for Medicaid may be eligible for health insurance on the marketplace or other forms of coverage. They will need help understanding how to transition. Outreach, education, and application assistance are key to helping people stay covered and may be the only way they learn the steps needed to keep their Medicaid coverage or move from Medicaid to another form of coverage.3

What should people enrolled in Medicaid do to stay covered? 
States are currently mailing important notices and may begin mailing renewal forms in the coming months. The most important step enrollees should take is to make sure the state Medicaid agency has their current mailing address and phone number.3

What should people do if they lose their Medicaid coverage? 
People who lose Medicaid for procedural reasons have 90 days to contact the Medicaid agency and submit their renewal paperwork. If they’re still eligible for Medicaid, the state is required to restore their coverage back to the date their coverage was terminated. People who miss the 90-day window must submit a new application. People who lose Medicaid because they are no longer eligible or were impacted by the unwinding will qualify for a special enrollment period on HealthCare.gov or their state-based marketplace.3

About Elevate Patient Financial Solutions®
Elevate Patient Financial Solutions® is a proven revenue cycle management partner that provides a range of services, including Medicaid Eligibility & Enrollment, Complex Claims, A/R Services and Self-Pay. Our Medicaid Eligibility & Enrollment services help patients enroll in available coverage programs, including Medicaid, to help pay for care. Our comprehensive in-house eligibility screening starts at the patient’s bedside with compassionate advocates who identify and secure any potential programs. We work closely with hospitals and healthcare facilities to educate Medicaid enrollees about the renewal process or help patients find other coverage. We also monitor evolving state landscapes to learn how Medicaid agencies are planning to resume eligibility and enrollment operations.

1. “CMCS Informational Bulletin,” Centers for Medicare & Medicaid Services, Jan 5, 2023. https://www.medicaid.gov/federal-policy-guidance/downloads/cib010523.pdf
2. “Fiscal and Enrollment Implications of Medicaid Continuous Coverage Requirement During and After the PHE Ends,” Kaiser Family Foundation, May 10, 2022. https://www.kff.org/medicaid/issue-brief/fiscal-and-enrollment-implications-of-medicaid-continuous-coverage-requirement-during-and-after-the-phe-ends/
3. “FAQ Unwinding Medicaid Continuous Coverage,” Center on Budget and Policy Priorities, February 2023. https://www.healthreformbeyondthebasics.org/wp-content/uploads/2023/01/FAQ-Unwinding-Medicaid-Continuous-Coverage.pdf
4. “Health Reform Monitoring Survey,” Urban Institute, June 2022. https://www.urban.org/sites/default/files/2022-11/Most%20Adults%20in%20Medicaid-Enrolled%20Families%20Are%20Unaware%20of%20Medicaid%20Renewals%20Resuming%20in%20the%20Future.pdf
5. “Unwinding the Medicaid Continuous Coverage Requirement Frequently Asked Questions,”
Center on Budget and Policy Priorities, The Center for Law and Social Policy, Suzanne Wikle and Jennifer Wagner, March 9, 2022. https://www.cbpp.org/research/health/unwinding-the-medicaid-continuous-coverage-requirement

Read our latest blog for an update on Medicaid unwinding: https://elevatepfs.com/medicaid_unwinding_disenrolls_millions/