March 17, 2023
In 2020, federal pandemic legislation required states to ensure “continuous coverage” for most people enrolled in Medicaid during the Public Health Emergency (PHE). In exchange, states received enhanced Medicaid funding. This meant that millions of people were able to keep their health insurance during the pandemic.
Congress’ year-end spending bill ends this requirement to keep people enrolled starting on April 1, 2023. States have 12 months to do eligibility redeterminations. You may hear of this as the “Medicaid unwinding” or the “PHE unwinding”. This means that states will be redetermining Medicaid eligibility for many Medicaid recipients. In a practical level, it means that people with Medicaid will need to renew their Medicaid health insurance and be determined eligible in order to stay insured.
As many as 15 million people could lose their Medicaid health insurance. Some of these people will no longer be eligible for the coverage based on their state’s eligibility rules. Others are at risk of losing coverage despite being eligible, because they will not successfully complete the renewal process, often for reasons outside of their control. While the unwinding will impact everyone on Medicaid today, survivors will face unique challenges in renewing their health insurance, and those survivors who are immigrants or who have limited English proficiency will face even more challenges and fear of immigration-related impacts.
State policymakers are working to address the policy challenges around reenrollment and redeterminations—and every state will be different in their policy and timeline. But there are many simple things that advocates can do now to support survivors who are enrolled in Medicaid. When working with survivors, talk to them about how they and their family get their health insurance. Most people on Medicaid are not aware that they will need to renew their Medicaid insurance this year.
What can you do now
If a survivor gets their insurance through Medicaid, encourage them to:
Make sure that the Medicaid agency has the most up-to-date mailing address and contact information. For those who do not have a secure or stable mailing address, it is possible to use a temporary address, such as the address of a trusted friend or family member.
Pay attention to the mail—look out for mail from the state health or Medicaid agency. Be sure to respond as soon as possible.
Assure survivors that everyone on Medicaid will need to renew soon. This isn’t a punitive policy—but it is important to follow the state’s requirements—and to take action—in order to stay insured.
Many survivors do have options for their health insurance. For those who remain eligible for Medicaid, their insurance will continue after the renewal. If a survivor is no longer eligible for Medicaid, affordable or free coverage may be available through the health insurance marketplace in their states. Health insurance is critically important for survivors to make getting physical and behavioral health more accessible and affordable.
Key Resources on the PHE Medicaid Unwinding:
What You Can Do to Help Kids Stay on Medicaid in 2023 (CLASP, January 2023) provides concrete steps for families and advocates to support enrollment.
End of Pandemic Medicaid Protections May Leave Many Immigrants without Health Insurance (NILC, February 2023)
The Looming Equity Crisis in Children’s Health Care: Federal and State Action Is Needed to Prevent Millions of Children from Losing Medicaid (UnidosUS, July 2022)
States Must Act to Preserve Medicaid Coverage as End of Continuous Coverage Requirement Nears (CBPP, February 2023)
Key FUTURES Resources on Supporting Survivors to Enroll in Health Insurance
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