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:
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- 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.
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- 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.
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- 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.
Resources
- Utah Medicaid COVID-19 Resources
- Presentation: Returning Medicaid Eligibility to Normal Operations when the Public Health Emergency Ends
- Unwinding Eligibility Plan
- Top 10 Fundamental Actions to Prepare for Unwinding
- Utah PHE Unwinding Key Risks
- Utah State Renewal Distribution Form
- Unwinding Eligibility Data Dashboard
- Utah Unwinding Baseline Report
- March 2023-Utah Unwinding Monthly Report
- April 2023-Utah Unwinding Monthly Report
- May 2023-Utah Unwinding Monthly Report
- June 2023-Utah Unwinding Monthly Report
- July 2023-Utah Unwinding Monthly Report
- August 2023-Utah Unwinding Monthly Report
Member Communications
- Letter: COVID-19 Uninsured Coverage Program (sent May 2022)
- Letter: PHE Unwinding Update (sent September 2022)
- Flyer: Update Your Address (mailed December 2021)
- Letter: General Notice about Continuous Medicaid Enrollment Ending (sent January 2023)
- Letter: Informational Notice about CHIP Premiums (sent February 2023)
- Letter: Informational Notice about Spenddown Payments and MWI Premiums (sent February 2023)
- Letter: Informational Notice for Emergency Medicaid Members (Sent February 2023)
- Frequently Asked Questions
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
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 about the end of the continuous enrollment requirement sent to all Medicaid & CHIP members |
February 2023 |
|
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 |
|
May 1, 2023 |
First group of CHIP quarterly premiums reinstated |
June 1, 2023 |
Second group of CHIP quarterly premiums reinstated |
July 1, 2023 |
|
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.