Unwinding COVID-19 Flexibilities January 2023 Update

On January 31, 2020, Health and Human Services (HHS) Secretary, Alex Azar, declared a nationwide public health emergency (PHE) for COVID-19 retroactive to January 27, 2020. Later, on March 18, 2020, Congress enacted the Families First Coronavirus Response Act (FFCRA), which included the requirement that Medicaid and the Children’s Health Insurance Program (CHIP) keep members continuously enrolled through the end of the month in which the COVID-19 PHE ends, in exchange for an enhanced Federal Medical Assistance Percentage (FMAP). In addition to continuous enrollment, under Section 1135 of the Social Security Act, the Centers for Medicare and Medicaid Services (CMS) modified or waived certain Medicaid and CHIP requirements during the PHE to give state more flexibility in administration of their programs and help residents access care.

However, CMS has made it abundantly clear that these provisions were temporary and would end upon expiration of the PHE. The Consolidated Appropriations Act, 2023 (CAA, 2023), passed on December 29, 2022, delinks the provisions of continuous enrollment and temporary FMAP increase from the end of the PHE and instead issued hard end dates for each. The CAA, 2023 establishes new, additional conditions for receiving the enhanced FMAP, including additional reporting requirements, for the remainder of the receipt of the enhanced FMAP, beginning April 1, 2023.

This issue brief explores the unwinding of Medicaid flexibilities introduced during the PHE, including the timeline for states to process renewals, initial key deliverables, reporting requirements, and considerations for states as they continue to work to return to their “pre-PHE” Medicaid and CHIP operations in 2023.