HomeMy WebLinkAboutMedicaid and CHIP CoverageThe End of the Continuous Enrollment Condition:
What Partners Need to Know About Medicaid and
CHIP Coverage
April 2023
M
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Disclaimer
This information is current at the time of presentation but Medicare and Medicaid policy is
subject to change. The contents of this document do not have the force and effect of law
and are not meant to bind the public in any way, unless specifically incorporated into a
contract. This document is intended only to provide clarity to the public regarding existing
requirements under the law. This communication was printed, published, or produced and
disseminated at U.S. tax payer expense.
This publication is a general summary that explains certain aspects of the Medicare,
Medicaid/CHIP, and Marketplace Programs, but is not a legal document. The official
Program provisions are contained in the relevant laws, regulations, and rulings. The
Centers for Medicare & Medicaid Services policy changes frequently, and links to the
source documents have been provided within the document for your reference.
Medicaid & CHIP Today: Enrollment Is at an All -Time High
In March 2020, the Families First Coronavirus
Response Act (FFCRA) established the
continuous enrollment condition, which gave
states extra federal Medicaid funding In
exchange for maintaining enrollment for most
individuals.
As a result of this legislation and flexibilities
adopted by states, Medicaid and Children's
Health Insurance Program (CHIP) enrollment
has grown to a record high.
Over 92 million individuals were enrolled in
health coverage through Medicaid and CHIP as
of December 2022.
This represents an increase of over 21 million
individuals, or nearly 31 percent, since
February 2020.
Ending the COVID-19 Continuous Enrollment Condition
• Under the Consolidated Appropriations Act 2023 (CAA, 2023), enacted in December 2022,
the FFCRA Medicaid continuous enrollment condition ended on March 31, 2023.
• States will resume normal operations, including restarting full Medicaid and CHIP eligibility
renewals and terminations of coverage for individuals who are no longer eligible.
• States are now able to terminate Medicaid enrollment for individuals no longer eligible as of
April 1, 2023.
• States will need to address a significant volume of pending renewals and other actions.
This is likely to place a heavy burden on the slate workforce and existing processes.
• When states resume full renewals, over 15 million people could lose their current
Medicaid or CHIP coverage.' Many people will then be eligible for coverage through the
Marketplace or other health coverage and need to transition.
• On January 30, 2023, the Biden-Harris Administration announced its intent to end the national
emergency and PHE declarations related to the COVID-19 pandemic on May 11, 2023.
Resuming Normal Eligibility and Enrollment Operations:
Expectations of States
As the continuous enrollment condition ends, states must initiate eligibility renewals for
the state's entire Medicaid and CHIP population within 12 months and complete
renewals within 14 months.
• States may have begun this process In February, March, or April 2023 but may
not have terminated eligibility for most individuals in Medicaid prior to April 1, 2023
States have 4 months to resume timely processing of all applications, including those
received after April 1, 2023.
The Centers for Medicare & Medicaid Services (CMS) has been working closely with
states for over a year to ensure that they are ready; that eligible enrollees retain
coverage by renewing their Medicaid or CHIP; and that enrollees eligible for other
sources of coverage, including through the Marketplace, smoothly transition.
CMS has also issued an array of guidance and tools to support state processing of
eligibility and enrollment actions, including new Flexibilities and requirements for states.
The Renewal Process
States must renew eligibility only once every 12 months for MAGI beneficiaries (most kids,
adults, pregnant individuals, etc.) and at least once every 12 months for non -MAGI beneficiaries
(e.g. aged, blind, disabled individuals).
States must begin the renewal process by first attempting to redetermine eligibility based on
reliable information available to the agency without requiring information from the individual (ex
parte renewal, also known as auto renewal, passive renewal, or administrative renewal).
• If available information is sufficient to determine continued eligibility, the state renews
eligibility and sends a notice.
• If available information is insufficient to determine continued eligibility, state sends a
renewal form and requests additional information from the beneficiary.
• For MAGI Medicaid, CHIP, and BHP, states must provide the individual at least 30
days to return the form. For Non -MAGI coverage, states must provide a reasonable
time frame
If the Medicaid agency determines that an individual is ineligible for Medicaid, the state
determines potential eligibility for other coverage like the Marketplace, and transfers the
individual's account information to the Marketplace for a determination.
Preparing for the Work Ahead
Most states have been actively preparing for the end of the continuous enrollment condition for
over a year. CMS has encouraged all states to:
• Develop an unwinding plan to prioritize and distribute renewals
• Obtain updated contact information to ensure that individuals receive information on redeterminations.
• Launch a robust outreach and communication plan for beneficiaries and stakeholders
• Engage community partners, health plans, and the provider community to amplify key messages and
to provide assistance with renewals
However, there are anticipated challenges to overcome:
• Large volume of renewals for states to complete
• Workforce challenges and staffing shortages experienced by state Medicaid and CHIP agencies
• The long length of time since many enrollees have had to complete a renewal
• The likelihood of outdated mailing addresses and other contact information for enrollees
Multiple resources are available to support both states and partners in this effort.
Medicaid.gov/Unwinding:
Resource Page for States and Partners
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Communications Strategy
• Campaign Goal
• Ensure individuals maintain coverage through renewal, or become enrolled, in the
source of coverage for which they are eligible, whether through Medicaid, CHIP, Basic
Health Program or the Marketplace
• Strategic Approach
• Multi -pronged, whole of government communications approach, in partnership with
the states and stakeholders, to ensure people with Medicaid are aware of the steps
they need to take to maintain coverage
• Create a national outreach campaign that builds on states' efforts and engages deeply
with partners and stakeholders
• Timeline
Phase I: Get Ready and Awareness
• Timeline: Underway and refreshed on February 1, 2023
Phase II: Medicaid Re -determination and Retaining Coverage
Medicaid and CHIP Continuous Enrollment Unwinding: A
Communications Toolkit
• A living resource where products will be added/updated as we learn
more about what stales, partners and consumers need to respond to � ..a"• "•� "�.n.
• Contains important information to help inform people with Medicaid or CHIP
about steps they need to take to renew their coverage
• Contents include:
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- Overview Tier kit r
- Summary of research with key insights P....,..,..
Key messagesher We herreer,
- Fillable digital flyers: "Have you heard the news? Your state Medicaid office is .m..r..�.",. o \�
restarting eligibility reviews"
- Drop in articles -
- Social media and outreach products
- Emails
- SMSfte#messages
- Call Center scripts �l
- CMS Partner Tp Sheet
• Available in English and Spanish. Select resources available in Chinese, Hindi.
Korean. Taoaloa. and Vietnamese.
Sample Communications Toolkit Materials
Social Media Graphics
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Call to Action and Key Messages for Partners
CMS Needs Your Helpl
What Partners Can Do NOW
Right now, partners can help prepare for the renewal process and educate Medicaid and CHIP enrollees about the upcoming
changes. This includes making sure that enrollees have updated their contact information with their State Medicaid or CHIP program
and are aware that they need to act when they receive a letter from their state about completing a renewal form.
Key Messages for Partners to Share
There are three main messages that partners should focus on now when communicating with people that are enrolled in Medicaid
and CHIP.
• Update your conduct informaion— Make sure Mame of State Medicaltl or CHIP program] has your current mailing address,
phone number, email, or other contact Information. This way, they'll be able to contact you about Your Medicaid or CHIP
several
• Check your mall -Name ofState Medicaid or CHIP programs will mall You a letter about your Medicaid or CHIP coverage.
This letter will also let you know if you need to complete a renewal form to see if You still qualify for Medicaid or CHIP.
• Complete your renewal loved (if you get one)— Fill out the form and return it to (Name of State Medicaid or CHIP programs
night away to help avoid a gap in Your Mail or CHIP coverage.
Sample social media posts, graphics, and drop-in articles that focus on these key messages can be found in the Communications Toolkit.
The Unwinding resource Pace will continue to be updated as new resources and tools are released.
Additional massaging will be shared in the future for Phase II, which focuses on ensuring Medicaid and CHIP enrollees take the necessary
steps to renew coverage, or transition to other several 0 they re no longer eligible for Medicaid or CHIP once Unwinding begins.
Federally-Facilitated Marketplace (FFM):
Overview of Key FFM Processes and
Updates on Plans for Medicaid Unwinding
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Process Flow: From State Transfer to Marketplace Enrollment
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to He llMCare.gov to apply for coverage.
"Eligibility reaube let the Consumer knew gthey're eligible to enmll in Marketplace plans and include information on any financial help they
may be able 0 use 0 lower the cost of coverage.
Medicaid Unwinding Special Enrollment Period (SEP)
To ensure individuals have sufficient time to enroll in Marketplace coverage during the unwinding period, consumers who lose
Medicaid/CHIP coverage between March 31, 2023 and July 31, 2026 will be eligible for a 60 -day SEP beginning the day they
submit or update a Marketplace application.
• Consumers can access this Unwinding SEP by submitting or updating an application through HealthCare.gov, a certified
partner that supports SEPs, or the Marketplace Call Center.
CMS has published Marketplace guidance on the unwinding SEP: httos:1/www.cms.gov/technical-assistance-resources/temp-
sen-unwinding fag.pdf
CMS recommends that MedicaidlCHIP enrollees submit or update an application on HealthCane gov as soon as they receive
their Medicaid/CHIP termination letter from their state.
More information can be found at: httos://www.healthcare.gov/medicaidchiottmnsfer-to-marketolace/
Overview: FFM Navigator and Other Assistance Personnel
Federally -Facilitated Marketplace Assisters (including Navigators and certified application counselors) provide free, unbiased
enrollment assistance and play a vital role helping consumers prepare applications to determine eligibility for and
enroll in coverage through the Marketplace and insurance affordability programs.
Assislers operate year-round—increasing awareness among the uninsured about the coverage options available to them,
helping consumers find affordable coverage that meets their needs, and assisting consumers to ensure they're equipped with
Me tools and resources needed to utilize and maintain their health coverage all year.
Right now, assisters in FFM states are helping their communities prepare for the unwinding period by encouraging consumers
ro:
1. update their correct mMrmaoon with their slate Medicaid or CHIP agency err
2. Look outfir a leaerfrem their vate alrout competing a renewal form.
The FFM has provided additional funding for Navigator grantees to facilitate direct consumer outreach, education, and
enrollment activities necessary to ensure seamless transitions into Marketplace coverage.
Assisters in FFM states will also receive unwinding -specific training, guidance and resources, In addition to other
programmatic supports geared towards fortifying consumer assistance best practices for Medicaid and Marketplace
populations.
Consumers can find assistance from Navigators and other assistance personnel in their area on Find Local Help at
How to Get Help Applying for Marketplace Coverage
If individuals need help completing a Marketplace application, they can:
• Visit HealthCare.gov
• HealthCare.gov will direct individuals to their state -based Marketplace, as applicable
• Call the Marketplace Call Center at 1-800-318-2596 (TTY: 1-855-889-4325)
• Visit httos://Iocalhelp.healthcare.gov/ to make an appointment with someone in their area who
can help
Information from Kim Stupica-Dobbs 4/17/2023 Joint Entities Presentation
BION
The Medicaid continuous enrollment condition ended on March 31, 2023, and stales will
be undertaking eligibility renewals for all individuals in their programs. If individuals lose
Medicaid coverage, they will be eligible for affordable Marketplace plans. You can find
free, local help for Marketplace enrollment, ask questions, and talk about plan choices
by visaing hllos://www. healthcamoov/find-assistance/
Full Information
Under what is known as the"continuous enrollment condition; State Medicaid agencies
have been unable to terminate enrollment for most individuals enrolled in Medicaid as of
March 18, 2020, as a condition of receiving a temporary funding increase. The
continuous enrollment condition ended on March 31, 2023, with states able to begin to
terminate Medicaid enrollment for individuals no longer eligible for Medicaid as early as
April 1, 2023. Stales will have up to 14 months to complete an eligibility renewal for all
individuals in their programs, and thus Medicaid coverage losses will occur over time.
This process is called the Medicaid continuous enrollment condition unwinding. Many
consumers who lose Medicaid coverage will be eligible for affordable Marketplace
plans.
Medicaid Continuous Enrollment Unwinding Overview:
•The earliest date states can terminate Medicaid coverage for consumers is April
1, 2023. Consumers who lose Medicaid or CHIP coverage between March
31, 2023, and July 31, 2024, are eligible for a Medicaid continuous
enrollment condition unwinding Special Enrollment Period
(SEP). Marketplace-eligible consumers losing Medicaid or CHIP coverage can
access the SEP by submitting or updating an application through
HealthCare.gov, a certified partner that supports SEPs, or the Marketplace Call
Center.
• Navigators and Enrollment Assistance Personnel (EAPs) will have the ability to
directly contact impacted consumers in Federally-facilitated Marketplaces
(FFMs) to help them understand available coverage options and find affordable
coverage that meets their needs, if requested. EAPs are additional contracted
assisters CMS is deploying in key locations across FFM states.
a Consumers may receive a letter including information for an Assister
Organization serving their community in advance of this Direct Assister-
to-Consumer Outreach.
o Consumer information will be securely shared with these Assister
organizations so that Assisters can conduct this outreach.
•You can find free, local help for Marketplace enrollment, ask questions, and
talk about plan choices by visiting httosJt%,ww.healthcare.aovttind-
assistance/
CMS Unwinding Resources
•Unwintling Homepage: The centralized location where states and stakeholders
can learn more about Unwinding and access resources to help them plan and
prepare.
•Medicaid and CHIP Renewals Patti A webpage designed for people enrolled
in Medicaid and CHIP to help them prepare W renew their coverage when
states restart eligibility renewals.
•Unwintling Communications Toolkit: The Unwinding Communications Toolkit
provides key messages and materials for states and stakeholders to use when
communicating with their networks about Medic antl and CHIP Continuous
Enrollment Unwinding. The toolkit is available in both Fund Ste.
Some outreach materials have also been translated
to Chinese, Hindi, Korean, Tagalog, and Vietnamese.
• Unwinding Toolkit Supporting Materials: This folder contains outreach
materials for partners, including flyers, postcards, tear pads, conference cards,
and the new Tip Sheet featured in the toolkit.
•Unwinding Speaking Request Form: Submit a request to have someone from
HHS or CMS speak about Unwinding at an upcoming event.
• Unwinding Special Enrollment Period — Pregnantly Asked Questions: On
January 31, 2023, CMS released information on a temporary Exceptional
Circumstances Special Enrollment Pei (SEP) for consumers losing
Medicaid or CHIP coverage due to unwinding of the Medicaid continuous
enrollment condition.
Additional CMS Resources
,Find Local Help Welowne
•HealthCarecov
•Certified Application Counselor Designated Organization (CDO) Program
Information
•Information on the Medicare Special Enrollment Period (SEP)