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.
- Letter: COVID-19 Uninsured Coverage Program (sent May 2022) opens in a new tab
- Letter: PHE Unwinding Update (sent September 2022) opens in a new tab
- Flyer: Update Your Address (mailed December 2021) opens in a new tab
- Letter: General Notice about Continuous Medicaid Enrollment Ending (sent January 2023) opens in a new tab
- Letter: Informational Notice about CHIP Premiums (sent February 2023) opens in a new tab
- Letter: Informational Notice about Spenddown Payments and MWI Premiums (sent February 2023) opens in a new tab
- Letter: Informational Notice for Emergency Medicaid Members (Sent February 2023) opens in a new tab
- Frequently Asked Questions
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
3 Tips to Help
4x6 Pass-Along Card
How to Help Toolkit
- Arabic opens in a new tab
- Burmese opens in a new tab
- Dari opens in a new tab
- English opens in a new tab
- Kinyarwanda opens in a new tab
- Marshallese opens in a new tab
- Pashto opens in a new tab
- Samoan opens in a new tab
- Spanish opens in a new tab
- Somali opens in a new tab
- Swahili opens in a new tab
- Tongan opens in a new tab
- Ukrainian opens in a new tab
How to Help Desk Reference
- Arabic opens in a new tab
- Burmese opens in a new tab
- Dari opens in a new tab
- English opens in a new tab
- Kinyarwanda opens in a new tab
- Marshallese opens in a new tab
- Pashto opens in a new tab
- Samoan opens in a new tab
- Spanish opens in a new tab
- Somali opens in a new tab
- Swahili opens in a new tab
- Tongan opens in a new tab
- Ukrainian opens in a new tab
Member Flyer
- Arabic opens in a new tab
- Burmese opens in a new tab
- Dari opens in a new tab
- English opens in a new tab
- Kinyarwanda opens in a new tab
- Marshallese opens in a new tab
- Pashto opens in a new tab
- Samoan opens in a new tab
- Spanish opens in a new tab
- Somali opens in a new tab
- Swahili opens in a new tab
- Tongan opens in a new tab
- Ukrainian opens in a new tab
- Utah Medicaid COVID-19 Resources
- Presentation: Returning Medicaid Eligibility to Normal Operations when the Public Health Emergency Ends opens in a new tab
- Unwinding Eligibility Plan opens in a new tab
- Top 10 Fundamental Actions to Prepare for Unwinding opens in a new tab
- Utah PHE Unwinding Key Risks opens in a new tab
- Utah State Renewal Distribution Form opens in a new tab
- Unwinding Eligibility Data Dashboard
- Utah Unwinding Baseline Report opens in a new tab
- March 2023-Utah Unwinding Monthly Report opens in a new tab
- April 2023-Utah Unwinding Monthly Report opens in a new tab
- May 2023-Utah Unwinding Monthly Report opens in a new tab
- June 2023-Utah Unwinding Monthly Report opens in a new tab
- July 2023-Utah Unwinding Monthly Report opens in a new tab
- August 2023-Utah Unwinding Monthly Report opens in a new tab
- September 2023-Utah Unwinding Monthly Report opens in a new tab
- October 2023-Utah Unwinding Monthly Report opens in a new tab
- November 2023-Utah Unwinding Monthly Report opens in a new tab
- December 2023-Utah Unwinding Monthly Report opens in a new tab
- January 2024-Utah Unwinding Monthly Report opens in a new tab
- February 2024-Utah Unwinding Monthly Report
- March 2024-Utah Unwinding Monthly Report
- April 2024-Utah Unwinding Monthly Report
- May 2024-Utah Unwinding Monthly Report
- June 2024- Utah Unwinding Monthly Report
- July 2024 - Utah Unwinding Monthly Report
- August 2024 - Utah Unwinding Monthly Report
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 |
|
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 |
|
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 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.