HHS Secretary Xavier Becerra Thanking Governors for Your Efforts Over The Last Three Years During The Coronavirus Disease 2019 (COVID-19) Pandemic.

Dear Governor:

Thank you for your efforts over the last three years to ensure people have health coverage during the Coronavirus Disease 2019 (COVID-19) pandemic.  As you know, Congress recently passed the Consolidated Appropriations Act, 2023 (CAA, 2023), which includes provisions that will end the Medicaid continuous enrollment condition under the Families First Coronavirus Response Act (FFCRA).  I write to you today regarding the Medicaid unwinding process that will occur as a result of the end of this condition.

The FFCRA, as originally enacted, allowed states to claim a temporary increase in federal Medicaid funds if they met certain conditions.  These conditions included a continuous enrollment condition that states had to meet until the last day of the month in which the COVID-19 public health emergency (PHE) ended.¹  While the CAA, 2023 did not address the end date of the COVID-19 PHE, it did establish an end date of March 31, 2023, for the continuous enrollment condition.  Therefore, starting April 1, 2023, states may begin terminating Medicaid enrollment for individuals who are no longer eligible, following a renewal.²

Today, Medicaid and the Children’s Health Insurance Program (CHIP) cover more than 91 million people, including families, children, pregnant women, seniors, and people living with disabilities.  When the continuous enrollment condition ends, states will have up to 12 months to initiate a renewal for all individuals enrolled in Medicaid, CHIP, or the Basic Health Program (BHP).  During this transition, it will be critical to ensure that every person is able to maintain coverage for which they are eligible, or transition to another form of affordable coverage.

While many states have adopted flexibilities offered by the Centers for Medicare & Medicaid Services (CMS) to improve enrollment operations, I remain concerned that some states have still not taken up these critical efficiencies to minimize coverage loss.  CMS stands ready to provide technical assistance on adoption of these and other mitigation strategies.  I urge you to ensure that your state is implementing every possible option to prevent eligible individuals from losing coverage.

The CAA, 2023 also extended the availability of the temporary increase in federal Medicaid funds under the FFCRA until December 31, 2023.  States cannot receive the temporary federal

Medicaid funding increase after April 1, 2023, unless they conduct renewals in compliance with federal requirements, attempt to ensure that they have up-to-date contact information for enrollees, and conduct outreach using multiple modalities before terminating eligibility for certain individuals based on returned mail.  The CAA, 2023 also requires all states to report to CMS on key metrics, including monthly renewal and termination data.  Additionally, the CAA, 2023 established new enforcement mechanisms for CMS if states do not comply with these new reporting requirements or with federal requirements pertaining to Medicaid renewals.

As the Secretary of Health and Human Services (HHS), one of my primary responsibilities is to ensure that the millions of people with Medicaid and CHIP coverage have the protections to which they are entitled.

Additionally, last month, I wrote to you with an update that HHS is planning for the COVID-19 PHE to end on May 11, 2023.  The Department continues to stand ready to support you in your efforts to prepare for the end of the COVID-19 PHE.  We have created a COVID-19 PHE landing page on our website where you can find resources we have previously shared with you regarding the transition from the PHE and where future resources will be uploaded as well.  Please do not hesitate to contact the HHS Office of Intergovernmental and External Affairs should you have questions regarding the end of the FFCRA continuous enrollment condition or the transition from the COVID-19 PHE.

Thank you for your continued partnership to protect health coverage and care.

Sincerely,
Xavier Becerra

Endnotes

¹ Under section 6008(b)(3) of the Families First Coronavirus Response Act (FFCRA), states claiming a temporary 6.2 percentage point increase in the Federal Medical Assistance Percentage (FMAP) have been unable to terminate enrollment for most individuals who were enrolled in Medicaid as of or after March 18, 2020, as a condition of receiving the temporary FMAP increase. When this continuous enrollment condition ends, states must, over time, return to normal eligibility and enrollment operations.

² While the requirements of section 6008 of the FFCRA do not apply to separate CHIPs or the Basic Health Program (BHP), CMS recognizes some states elected to apply certain provisions of section 6008 to their separate CHIP program or BHP. In those circumstances, subject to exceptions noted and other federal requirements, guidance related to unwinding from the Medicaid continuous enrollment condition also applies to CHIP and BHP. For more information, please see https://www.medicaid.gov/unwinding and the State Health Official letter, “Medicaid Continuous Enrollment Condition Changes, Conditions for Receiving the FFCRA Temporary FMAP Increase, Reporting Requirements, and Enforcement Provisions in the Consolidated Appropriations Act, 2023”: https://www.medicaid.gov/federal-policy-guidance/downloads/sho23002.pdf