Unwinding Continuous Medicaid Eligibility

Continuous Eligibility Background

At the beginning of the COVID-19 pandemic, the federal government declared a public health emergency or PHE. During the PHE, state Medicaid agencies have been required to continue Medicaid coverage for all members, even if their eligibility changes. As a result, Utah Medicaid members have stayed covered during the PHE so they don't have to worry about their health coverage during this 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 establishes April 1, 2023, as the end of the continuous enrollment requirement for Medicaid. The federal PHE will end on May 11, 2023, which will also end the COVID-19 Uninsured Coverage Medicaid program.

Unwinding Medicaid Eligibility

On March 1, 2023 the Department of Workforce Services (DWS) will begin to review all Medicaid cases over the next 12-month unwinding period.  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 Continuous Eligibility Unwinding 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), 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. After February 11, members can check myCase 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. 

For additional information for members, please read this helpful FAQ.  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.

Provider and Partner Communications

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

Important Dates and Timeline


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 about the end of the continuous enrollment requirement sent to all Medicaid & CHIP members

February 2023

  • Notify CHIP members that quarterly premiums will resume
  • Notify Medically Needy members that their monthly spenddowns will be required following their first renewal
  • Notify 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 

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

Members who are no longer eligible with a known eligibility reason will be directly transferred to the federal Health Insurance Marketplace. 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 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’s application assistors may be able to help.  Call 211 to schedule a free appointment.