Unwinding Continuous Medicaid Eligibility

At the beginning of the COVID-19 pandemic, the federal government declared a public health emergency or PHE. During the PHE, state Medicaid agencies were required to continue Medicaid coverage for all members, even if their eligibility changed. As a result, Utah Medicaid members stayed covered during the PHE so they didn't have to worry about their health coverage during such a challenging time.

On December 23, 2022, Congress passed the FY 2023 Consolidated Appropriations Act. One part of this bill separated the federal PHE and Medicaid’s continuous enrollment policy. This Act established April 1, 2023, as the end of the continuous enrollment requirement for Medicaid. The federal PHE ended on May 11, 2023, which also ended the COVID-19 Uninsured Coverage Medicaid program.

On March 1, 2023 the Department of Workforce Services (DWS) began reviewing eligibility for all Medicaid cases and will continue until April 2024. This is being referred to as “unwinding.” Members will be assigned a review month and their case will stay open until their scheduled review month. Members are encouraged to continue using their benefits as normal until DWS completes their review.

To monitor this process over the course of those 12 months, DWS will provide transparent tracking data which will be available and updated on the Unwinding Eligibility Data Dashboard.

Call to Action

Many people moved during the pandemic. It is critical that the state is able to reach members when it is time to review their eligibility. Utah Medicaid is asking members to:

Keep their contact information current

If a member moved during the pandemic or if any of their contact information like their phone number or email address has changed, please call their health plan, DWS (1-866-435-7414 or jobs.utah.gov/mycase opens in a new tab), or an HPR (1-866-608-9422) to update this information.

Watch for DWS letters ‐ Members should pay close attention to their mail and/or email for notices and respond timely to reviews. Members can also check myCase opens in a new tab to see their review date.

Complete review ‐ All medical programs are renewed each year. In a member’s assigned review month, DWS will try to complete the review without member involvement and send the member a notice saying their review is complete. If DWS does not have enough information, the member will be asked to complete their review. Helpful videos and instructions on completing a review are available on the DWS website opens in a new tab.

For additional information for members, please read this helpful FAQ opens in a new tab. Since DWS eligibility will need to review all Medicaid cases in the next year, we are asking members to wait until they receive their review before taking action. During this time callers may experience longer call wait times to speak to a DWS eligibility worker.

What can I do if I lose my Medicaid health insurance?

We want all Utahns to get health insurance and stay covered. You will get the following things if you don’t qualify for Medicaid anymore:

A letter that tells you when your Medicaid health insurance will end.
You’ll be automatically transferred to the federal Health Insurance Marketplace opens in a new tab (as long as you send in the required paperwork and supporting documents).
Information about the federal Health Insurance Marketplace opens in a new tab.
Information about how to appeal. This means you can ask them to review your case again if you think you should qualify, but DWS sent you a letter that says you don’t qualify for Medicaid anymore.

Pay attention to the deadlines.

You must file an appeal within 90 days.
You won’t be automatically transferred to the federal health insurance marketplace if you lose your Medicaid benefits because you didn’t return the paperwork they asked for.

What does it mean to be automatically transferred to the federal health insurance marketplace?

People who are no longer eligible for Medicaid will be automatically transferred to the federal Health Insurance Marketplace (healthcare.gov). There is currently an automatic process for this transfer to take place as long as a determination is made. The transfer will not happen if they lose Medicaid coverage because they do not complete or return their paperwork.

What other health insurance options are there?

People who do not qualify for Medicaid health insurance can still get coverage through the federal Health Insurance Marketplace or healthcare.gov opens in a new tab. Most people qualify for savings on a health plan to lower their monthly premium and co-pays. Savings are based on their household size and income. All Marketplace plans cover things like prescription drugs, doctor visits, urgent care, hospital visits, and more.

People who lose Medicaid have 60 days to apply for health insurance on the Marketplace.

Health insurance plans usually have an open enrollment period each year when people can sign up for health insurance. They only let someone sign up during open enrollment, unless they have a “qualifying life event”. It is considered a “qualifying life event” if someone doesn’t qualify for Medicaid anymore. This means people have 60 days after their Medicaid benefits end to sign up for a new health insurance plan.

You’ll have to wait until the next open enrollment period if you don’t sign up for a new health insurance plan within 60 days of when your Medicaid benefits end. It’s also important to know you won’t be transferred to the federal health insurance marketplace if you lose your Medicaid benefits because you didn’t meet the deadlines or return the paperwork or supporting documents DWS asked for.

Call 211 to schedule a free appointment with Take Care Utah opens in a new tab if you need help to sign up for a new health insurance plan.

If you would like to order printed materials for your organization to distribute, please email medicaidoutreach@utah.gov .

General Information

Unwinding Communication Toolkit

English opens in a new tab
Spanish opens in a new tab
PHE Unwinding Benefit Flexibilities opens in a new tab
Unwinding Talking Points for Customer Service
- English opens in a new tab
- Spanish opens in a new tab

3 Tips to Help

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4x6 Pass-Along Card

How to Help Toolkit

How to Help Desk Reference

Member Flyer

Important Dates and Timeline

Date	What’s Coming?
December 29, 2022	Consolidated Appropriations Act (CAA) sets the Medicaid continuous enrollment end date April 1, 2023
End of January	General notice opens in a new tab about the end of the continuous enrollment requirement sent to all Medicaid & CHIP members
February 2023	Notify opens in a new tab CHIP members that quarterly premiums will resume Notify opens in a new tab Medically Needy members that their monthly spenddowns will be required following their first renewal Notify opens in a new tab Emergency Medicaid recipients that they can “raise their hand” if there has been a change to their immigration status and should now be considered for full Medicaid benefits
February 11, 2023	Review dates set on eligibility cases and members can see their review date in myCase opens in a new tab
February 13, 2023	Unwinding Eligibility Data Dashboard posted online showing workload and other key metrics
March 1, 2023	DWS begins the priority review Medicaid cases
April 1, 2023	Enhanced Federal Medical Assistance Percentage (FMAP) decreases from 6.2% to 5%
April 30, 2023	First transfers to the Federal Marketplace from reviewing cases First incomplete reviews will close
May 1, 2023	First group of CHIP quarterly premiums reinstated
June 1, 2023	Second group of CHIP quarterly premiums reinstated
July 1, 2023	Last group of CHIP quarterly premiums reinstated Enhanced FMAP decreases from 5% to 2.5%
October 1, 2023	Enhanced FMAP decreases from 2.5% to 1.5%
January 1, 2024	Enhanced FMAP ends
April 30, 2024	All Medicaid and CHIP cases reviewed to complete unwinding

Medicaid Coverage Loss

We want all eligible Utahans to get covered and stay covered. If a member is no longer eligible for Medicaid, they will receive:

Advanced notice of when their enrollment ends
Information on how to appeal
Information about options for purchasing other health care coverage
A direct transfer to the federal Health Insurance Marketplace opens in a new tab

Members who are no longer eligible with a known eligibility reason will be directly transferred to the federal Health Insurance Marketplace. opens in a new tab There is currently an automatic process for this transfer to take place as long as a determination is made (transfer will not occur when a case is closed for failing to complete or return paperwork).

Losing Medicaid or CHIP coverage is a Qualifying Life Event, which allows an individual or family to enroll in a Marketplace plan outside of the Open Enrollment Period. Visit HealthCare.gov opens in a new tab or call the Marketplace Call Center at 1-800-318-2596 (TTY: 1-855-889-4325) to get details about Marketplace coverage.

If you need help applying for health insurance, Take Care Utah opens in a new tab ’s application assistors may be able to help. Call 211 to schedule a free appointment.