Consequences of the Medicaid Unwinding

On March 18, 2020, The Families First Coronavirus Response Act mandated continuous coverage for Medicaid enrollees during the public health emergency. Over the next three years Medicaid enrollment grew by 23 million people.  At the end of 2022, the Consolidated Appropriations Act, 2023 was signed into law ending the continuous enrollment as of March 31, 2023.   States have up to 12 months to initiate, and 14 months to complete, a renewal for all individuals enrolled in Medicaid, CHIP, and the Basic Health Program — this process is commonly being referred to as “Medicaid Unwinding.”

States were required to submit State Renewals Reports “to describe how they intend to distribute renewals as well as the processes and strategies the state is considering or has adopted to mitigate against inappropriate coverage loss during the unwinding period.” States also submit monthly reports to assess the state’s plans for processing renewals when states begin restoring routine Medicaid and CHIP operations.

There are estimates that suggest that as many as 24.4 million enrollees could lose coverage during the 12-month unwinding period. A recent survey of Medicaid enrollees found that two-thirds of people were not sure if their state was returning to regular Medicaid operations. As of June 22, 2023, public reports tell us that at least 1.5 million Medicaid enrollees have been disenrolled in 25 states and DC with 73 percent of people disenrolled had their coverage terminated for procedural reasons even if they are still eligible for Medicaid coverage. Procedural disenrollments are cases where people are disenrolled because they did not complete the renewal process because of outdated contact information or they did not complete renewal packets within a specific timeframe.

Given the high number of people losing coverage due to administrative processes,  the U.S. Department of Health and Human Services (HHS) reached out to states on June 12, 2023, urging them to utilize additional state strategies. This includes auto renewals by maximizing the use of data sources such as SNAP or TANF and partnering with managed care plans to ensure that contact information is up to date. Efforts to conduct outreach, education and provide enrollment assistance can help ensure that those who remain eligible for Medicaid are able to retain coverage and those who are no longer eligible can transition to other sources of coverage.

The CMS Unwinding Homepage is the centralized location to learn more can more about Unwinding and access resources. Unwinding Communications Toolkit provides key messages and materials. Each state offers a variety of tools that can be found on Georgetown’s 50 State Unwinding Tracker.

Communicating with patents is key.

• Add banners on your website and post on social media
• Send notices via text messages and email
• When scheduling patients, create scripts and include information with any additional communications
• Push portal notifications to patients
• Post relevant information in critical points of access
• Include unwinding messaging in your statement mailers

Within your organization, you should:

• Run reports to determine the impact
• Understand the possible impact to cash and delays in the Medicaid approval process
• Develop a communication plan for patients
• Reach out to MCOs
• Educate staff regarding unwinding and have scripting and flyers available

Finally, healthcare providers are in the unique position to reach out to patients, payers, government officials, and community organizations.