HHS Reminds States of Legal Obligations to Federal Civil Rights Protections as States Transition from Medicaid Continuous Coverage Changes as the Public Health Emergency Ends
Letter underscores need for meaningful language access for individuals with limited English proficiency and effective communication for individuals with disabilities during states’ unwinding of Medicaid Continuous Enrollment Condition
Today the U.S. Department of Health & Human Services Office for Civil Rights (OCR) reminded states of their obligations under federal civil rights laws as the Public Health Emergency for COVID-19 and the continuous Medicaid coverage comes to an end, and states restart Medicaid and Children’s Health Insurance Program (CHIP) eligibility reviews. The Families First Coronavirus Response Act (FFCRA) allowed for continuous Medicaid and CHIP coverage during the COVID-19 Public Health Emergency. The expiration of this requirement presents the single largest health coverage transition event since the first open enrollment period of the Affordable Care Act. As a result of the Consolidated Appropriations Act, 2023, this continuous enrollment condition ended March 31, 2023; states must, over time, return to normal eligibility and enrollment operations, in a process referred to as “unwinding.” As states begin unwinding, they are communicating with individuals and families to receive more information to make a coverage decision, provide information on eligibility and marketplace plans, and send people a renewal letter in the mail. Most children can still be covered through the Children’s Health Insurance Program. Today’s letter makes clear that states have independent obligations under federal civil rights laws to ensure that individuals and families continue to have access to Medicaid and Children’s Health Insurance Program coverage upon the expiration of the FFCRA continuous enrollment condition.
“As states head into this unwinding period, prioritizing language access and effective communication obligations will go far to prevent people of color and individuals with LEP or disabilities from being disenrolled as a result of inaccessible communications,” said OCR Director Melanie Fontes Rainer. “OCR is deeply committed to helping states ensure that eligible individuals with LEP and individuals with disabilities are provided with meaningful language access and effective communication to ensure they do not experience an otherwise unnecessary lapse in coverage. OCR is available to provide technical assistance to states and encourages agencies to take proactive steps to ensure meaningful access and effective communication by developing, reviewing, and/or updating plans for the provision of these vital services, including how people will be informed of the availability of language assistance services and auxiliary aids and services.”
According to recent census data, approximately 68 million people in the United States speak a language other than English at home, and up to 1 in 4 adults have some type of disability. As of November 2022, nearly 92 million individuals were enrolled in Medicaid and the Children’s Health Insurance Program. The Department’s Assistant Secretary of Planning and Evaluation (ASPE) estimates that, approximately 15 million individuals will leave Medicaid and Children’s Health Insurance Program based on historical patterns of coverage loss.
Title VI of the Civil Rights Act of 1964 (Title VI), Section 504 of the Rehabilitation Act of 1973 (Section 504), Title II of the Americans with Disabilities Act (Title II), and Section 1557 of the Affordable Care Act (Section 1557) prohibit entities receiving federal financial assistance from discrimination on the basis of, among other things, race, color, national origin, and disability. This means covered entities must provide an equal opportunity to participate in and benefit from programs; communications with individuals with disabilities must be as effective as with others; and reasonable steps must be taken to provide meaningful access to people with LEP. States must ensure their communications during the unwinding period comply with these laws.
Read OCR’s letter here: https://www.hhs.gov/sites/default/files/medicaid-unwinding-letter.pdf
OCR has been and will continue to support the Centers for Medicare and Medicaid Services (CMS) in its outreach efforts regarding the unwinding. OCR joined a recent webinar on the topic and plans to participate in future events. As states develop and execute their unwinding operational plans, OCR is available to provide ongoing technical assistance regarding their language access and effective communication obligations.
If you believe that you have been discriminated against in programs or activities that HHS directly operates or to which HHS provides federal financial assistance, you may file a complaint for yourself or someone else at: https://www.hhs.gov/civil-rights/filing-a-complaint/index.html.
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