The Medicaid Unwinding
Understanding the Medicaid Unwind
Frequently Asked Questions
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As part of its COVID-19 response efforts, Congress passed the Families First Coronavirus Response Act on March 18, 2020. This bill includes enhanced federal funding for state Medicaid agencies to provide care throughout the duration of the federal public health emergency (PHE). As a condition of receiving this enhanced federal funding, states were prevented from terminating people’s Medicaid coverage in most circumstances. This continuous coverage requirement was designed to ensure that people did not lose their health insurance during the pandemic and has resulted in significant growth in Medicaid enrollment and contributed to the national uninsured rate reaching an all-time low in 2022.
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On December 23, 2022, Congress passed the Consolidated Appropriations Act of 2023, which set an end date for the continuous coverage requirement. Under the law, state Medicaid agencies can begin processing Medicaid eligibility terminations as early as April 1, 2023, and will complete redeterminations for all members within 14 months. During this period, 5–14 million people nationwide are expected to lose Medicaid coverage. Of those, up to 7 million people will erroneously lose Medicaid coverage despite ongoing eligibility.
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As the largest payer for maternity care in the United States, Medicaid plays a crucial role in the delivery of obstetric and gynecological services. During the PHE, pregnant people who were eligible for Medicaid saw the largest percentage increase in enrollment of any eligibility category, with approximately 64% more beneficiaries in April 2022 compared to February 2020. A growing body of research suggests that unsafe gaps in health insurance coverage exacerbate poor maternal health outcomes and cause people to forgo postpartum care.
Medicaid coverage during the unwinding will vary significantly depending on the state. Additionally, more than 28 states and Washington, D.C., have taken up the 12-month postpartum coverage option, with several more expected to extend postpartum coverage soon. Pregnant people in states that have taken up the option will have 12 months of Medicaid coverage from the date of their delivery regardless of where their state is in the unwinding process. However, those in states that have not elected to extend postpartum coverage may lose coverage 60 days after delivery as early as this spring. For more information about the current status of postpartum coverage in your state, see ACOG’s resource on the status of state actions to extend postpartum Medicaid coverage.
Obstetricians and gynecologists should encourage their patients to update their mailing address and contact information with their state Medicaid agency and respond to verification requests from the Medicaid agency. See the chart below for additional state guidance.
State Resources
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District of Columbia
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Georgia
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Illinois
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Massachusetts
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Michigan
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Minnesota
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Oklahoma
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South Dakota
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Tennessee
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Utah
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West Virginia
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Wisconsin
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Wyoming
Extend Postpartum Medicaid Coverage
States are taking action to extend postpartum Medicaid coverage. ACOG continues to work with the White House and Congress to include provisions that permanently extends, and requires, Medicaid coverage continuously for 12 months postpartum.
GoMore Information on the Medicaid Unwinding
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Unwinding and Returning to Regular Operations after COVID-19 (CMS)
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Medicaid and CHIP Unwinding Planning Efforts: Summary of Best and Promising State Practices from CMS/State Discussions
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CMS Letter to State Health Officials
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What Happens When COVID-19 Emergency Declarations End? Implications for Coverage, Costs, and Access
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Anticipated 2023 State Timelines for Initiating Unwinding-Related Renewals as of February 24, 2023 (CMS)
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Medicaid and CHIP Continuous Enrollment Unwinding Partner Education Webinar Series (CMS)
Resources for Your Practice
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Medicaid and CHIP Continuous Enrollment Unwinding: A Communications Toolkit (CMS)
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Medicaid Unwinding Communications Toolkit Downloads (CMS)
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Medicaid PHE Unwinding Full Page Graphic for Providers (CMS)
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Medicaid PHE Unwinding Half Page Graphic for Providers (CMS)
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Factsheet on Employer Sponsored Coverage (CMS)
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Factsheet on Employer Sponsored Coverage—Spanish (CMS)