Supporting States in Prioritizing Coverage Retention and Health Equity When the Medicaid Continuous Coverage Requirement Ends

A series from State Health and Value Strategies provides resources to support states in “unwinding” and prioritizing coverage retention when the Medicaid continuous coverage requirement ends.

This page is updated as new resources become available. The most recent update was made in March 2023.

The Issue

The Families First Coronavirus Response Act (FFCRA) Medicaid continuous coverage requirement has allowed people to retain Medicaid coverage and get needed care during the pandemic. On December 29, 2022, President Biden signed into law the Consolidated Appropriations Act, 2023 (CAA), an omnibus funding package that decouples the continuous coverage provision from the end of the COVID-19 public health emergency by providing a fixed end date of March 31, 2023. The CAA also includes a gradual phase down of the enhanced federal match rate and new guardrails to prioritize coverage retention and smooth coverage transitions during the unwinding.

Over the course of 2023 and into 2024, states will need to redetermine eligibility for nearly all 92 million Medicaid/Children's Health Insurance Program (CHIP) enrollees—threatening the historic gains in coverage achieved as a result of continuous coverage. While most people will continue to be eligible for coverage, terminations of Medicaid/CHIP coverage and eligibility transitions are likely to disproportionately impact Black, Latino/a and other people of color.

State Health and Value Strategies has developed a series of products and programming to serve as a resource for states in unwinding the continuous coverage requirement. Materials build on federal sub-regulatory guidance, best practices from states across the country, and input from consumer advocates to provide resources for states seeking to optimize coverage retention for consumers who remain eligible for Medicaid or who are eligible for subsidized Marketplace coverage or employer-sponsored insurance.

The latest brief in the series, "The State of Medicaid Enrollment Approaching Unwinding," examines how Medicaid enrollment growth has substantially outpaced pre-COVID-19 rates of growth in the program, particularly among non-elderly, non-disabled adults.

Key Findings

• People of color are overrepresented in the Medicaid program and are more likely to experience volatility and instability in employment and housing as a result of longstanding, structural racism, thus increasing the chances that these individuals could lose coverage for administrative reasons when the continuous coverage requirement ends. States therefore have a clear imperative to center health equity as they plan for the end of the continuous coverage requirement.
  
• To ensure eligible individuals don’t churn off coverage once the continuous coverage requirement ends, states can take steps to improve consumer communications, partner with stakeholders, and ensure Medicaid/Marketplace coordination.
  
• The Centers for Medicare & Medicaid Services (CMS) has released sub-regulatory guidance and tools to support state Medicaid and CHIP agencies in returning to normal eligibility operations once the continuous coverage guarantee expires.
• States can also strengthen eligibility and enrollment processes and implement policy, and operational strategies to update contact information to ensure eligible enrollees are able to keep or transition to new affordable health coverage.
  
• From February 2020 through December 2022, the median state among the 24 states with available data for that period saw total enrollment growth of 30.6 percent, with the average state continuing to see monthly growth well above pre-pandemic levels.
  

Conclusion 

The end of the continuous coverage requirement presents the single largest health coverage transition event since the first open enrollment of the Affordable Care Act (ACA). Federal and state policymakers and other stakeholders are engaging in robust planning and implementation efforts to prioritize continuity of coverage and ensure that the end of the continuous coverage requirement does not exacerbate already widespread racial and ethnic disparities in the American healthcare system.

About State Health and Value Strategies—Princeton University School of Public and International Affairs

State Health and Value Strategies (SHVS) assists states in their efforts to transform health and healthcare by providing targeted technical assistance to state officials and agencies. The program is a grantee of the Robert Wood Johnson Foundation, led by staff at Princeton University’s School of Public and International Affairs. The program connects states with experts and peers to undertake healthcare transformation initiatives. By engaging state officials, the program provides lessons learned, highlights successful strategies and brings together states with experts in the field. Learn more at www.shvs.org.

About Manatt Health

Manatt Health integrates legal and consulting expertise to better serve the complex needs of clients across the healthcare system. Our diverse team of more than 160 attorneys and consultants from Manatt, Phelps & Phillips, LLP and its consulting subsidiary, Manatt Health Strategies, LLC, is passionate about helping our clients advance their business interests, fulfill their missions, and lead healthcare into the future. For more information, visit https://www.manatt.com/Health.

Contributors to this series include: Georgetown University Health Policy Institute Center on Health Insurance Reforms; GMMB; Health Equity Solutions; Jason Levitis, Levitis Strategies; and the State Health Access Data Assistance Center (SHADAC).