Beginning February 1, 2023, states are authorized to resume Medicaid and CHIP eligibility redetermination for all beneficiaries currently enrolled but restricted from disenrollment of ineligible beneficiaries until April 1st. Signed into law by President Biden on December 29, 2022, the Consolidated Appropriations Act, 2023 (also known as the Omnibus Spending Bill), ends the Medicaid continuous enrollment requirements of the Families First Coronavirus Response Act (FFCRA).

Under the FFCRA continuous enrollment requirements, states were not allowed to terminate Medicaid eligibility except in very limited circumstances as a condition for receiving a 6.2 percent increase in the Medicaid federal match rate.

According to the most recent data available, enrollment in Medicaid and the Children’s Health Insurance Program (CHIP) grew by 20.2 million people (28.61%) between February 2020 and  September 2022 – reaching over 90.9 million people across the nation.[1] Most of this increase is attributed to the FFCRA continuous enrollment requirement.

Starting April 1st, the continuous enrollment requirement will no longer be linked to the end of the COVID-19 Public Health Emergency (PHE). This gives states a short time to finalize their Medicaid "unwind" plans and resume "normal" Medicaid and CHIP eligibility determinations. This gives states a short time to finalize their Medicaid “unwind” plans and resume “normal” Medicaid and CHIP eligibility redeterminations.

While states have up to 12 months to initiate their renewal and redistribution efforts, the Consolidated Appropriations Act, 2023 incentivizes states to make optimal use of that time by ramping down the FFCRA increased Medicaid federal match each quarter of 2023 – starting at 6.2 percent in January and dropping down to 1.5 percent during the fourth quarter. 

This daunting redetermination effort kicks off at a time when many Medicaid agencies are struggling to attract job applicants to fill open positions in a workforce shrunken by retirements and attrition.

As the nation’s leading provider of Medicaid eligibility and enrollment services, Maximus is ready to help state Medicaid agencies meet this significant but temporary surge. It is essential that states help individuals navigate through the redetermination process – ensuring covered populations who remain eligible can maintain coverage, and individuals who are no longer eligible can shift to other healthcare coverage options.

States have turned to Maximus as their trusted partner for nearly 50 years to respond to a variety of changing needs, circumstances, and challenges. We augment state workforces with highly trained people, resources, and technologies while maintaining customer service and program integrity. We currently assist more than 60 percent of Medicaid beneficiaries to select and enroll in Medicaid-managed care plans. Specific examples of our work include handling surges in consumer calls and eligibility redeterminations, performing enrollment broker services, helping consumers understand their health plan options, assisting with appeals processing, and helping states agencies meet federal reporting requirements. Specific examples of our work include handling call surges, eligibility redetermination and renewals, performing enrollment broker services, helping consumers understand their health plan options, appeals processing, and helping states agencies meet federal reporting requirements.

Download the PHE Unwinding e-Book

For more information, contact us at USServices@maximus.com.

[1]September 2022 Medicaid and CHIP Enrollment Snapshot