DEPARTMENT OF HEALTH & HUMAN SERVICES 
Centers for Medicare & Medicaid Services 
200 Independence Avenue, SW 
Washington, DC 20201 
 
 
 
CMCS Informational Bulletin 
 
DATE:   May 8, 2023 
 
FROM:   Daniel Tsai, Deputy Administrator and Director, Center for Medicaid & CHIP 
Services 
 
SUBJECT:   End of the COVID-19 Public Health Emergency (PHE) and the COVID-19 
National Emergency and Implications for Medicaid and the Childrens Health 
Insurance Program (CHIP)  
 
Background 
 
On February 9, 2023, the Secretary of Health and Human Services (Secretary) announced that on 
May 11, 2023 he plans to let the COVID-19 PHE he declared pursuant to section 319 of the 
Public Health Service (PHS) Act expire.1 The announcement of this end date aligned with the 
Administrations previous commitments to give at least 60 days notice prior to the end of this 
COVID-19 PHE. As discussed below, end dates for certain COVID-19-related Medicaid and 
CHIP coverage and enhanced federal matching funds are tied to the end of this COVID-19 PHE. 
Throughout this document, we use the term COVID-19 PHE to refer to the Secretary-declared 
PHE for COVID-19 under section 319 of the PHS Act.  
 
This Center for Medicaid & CHIP Services (CMCS) Informational Bulletin (CIB) describes the 
end dates of certain COVID-19-related Medicaid and CHIP coverage and enhanced federal 
funding if the COVID-19 PHE ends on May 11, 2023, as expected. As part of their response to 
the COVID-19 PHE, states adopted many temporary flexibilities to support providers and 
individuals enrolled in Medicaid and CHIP. CMCS has previously provided information through 
CMCS All-State Calls2 and other resources3 on how states can continue many of these 
flexibilities beyond the COVID-19 PHE, if permissible. See the Appendix for key dates for 
expiration of Medicaid and CHIP COVID-19 requirements and flexibilities, including but not 
limited to coverage requirements under the American Rescue Plan Act of 2021 (ARP). CMCS 
continues to be available to provide states with technical assistance as they prepare to return to 
routine operations.  
 
 
                                                      
1 https://www.hhs.gov/about/news/2023/02/09/letter-us-governors-hhs-secretary-xavier-becerra-renewing-covid-19-public-
health-emergency.html.  
2 https://www.medicaid.gov/resources-for-states/coronavirus-disease-2019-covid-19/cmcs-medicaid-and-chip-all-state-
calls/index.html  
3 https://www.medicaid.gov/state-resource-center/downloads/mac-learning-collaboratives/medicaid-chip-inventory.pdf   Page 2  CMCS Informational Bulletin 
 
 
On April 10, 2023, President Biden signed into law a joint resolution of Congress that ended the 
Presidentially declared COVID-19 National Emergency on that date.4 This emergency, which we 
refer to throughout this document as the COVID-19 National Emergency, is separate from the 
COVID-19 PHE declared by the Secretary. As discussed above, the COVID-19 PHE is expected 
to remain in effect until May 11, 2023, unless the Secretary ends the COVID-19 PHE on a 
different date (for example, if directed to do so by the President). Please see below for more 
information about the impact of the end of the COVID-19 National Emergency on Medicaid and 
CHIP. 
 
CMCS reminds states that the end of the continuous enrollment condition for individuals 
enrolled in Medicaid is no longer linked to the end of the COVID-19 PHE and is also not 
impacted by the end of the COVID-19 National Emergency. Under the Families First 
Coronavirus Response Act (FFCRA), states claiming a temporary 6.2 percentage point increase 
in the Federal Medical Assistance Percentage (FMAP) were unable to terminate enrollment for 
most individuals enrolled in Medicaid as of or after March 18, 2020, as a condition of receiving 
the temporary FMAP increase. The Consolidated Appropriations Act, 2023 (CAA, 2023), signed 
into law on December 29, 2022, ended the continuous enrollment condition on March 31, 2023. 
As of April 1, 2023, states are permitted to terminate Medicaid enrollment for individuals for 
whom the state has completed a renewal and determined are no longer eligible during the states 
unwinding period. For more information on the end of the continuous enrollment condition, 
please visit Medicaid.gov/unwinding and see the recent State Health Official Letter, Medicaid 
Continuous Enrollment Condition Changes, Conditions for Receiving the FFCRA Temporary 
FMAP Increase, Reporting Requirements, and Enforcement Provisions in the Consolidated 
Appropriations Act, 2023.5 This CIB does not provide any additional information about the end 
of the continuous enrollment condition. 
COVID-19-Related Medicaid and CHIP Coverage 
 
ARP Section 9811 and Section 9821: Coverage of COVID-19 Vaccines, Vaccine Administration, 
Testing, and Treatment in Medicaid and CHIP 
Since March 11, 2021, the ARP has required state Medicaid and separate CHIP programs to 
cover COVID-19 vaccines and their administration, testing for COVID-19, and treatments for 
COVID-19 without cost-sharing.6 Additionally, since March 11, 2021, state Medicaid and 
separate CHIP programs must cover, without cost-sharing, the treatment of a condition that may 
seriously complicate the treatment of COVID-19, if otherwise covered under the state plan (or a 
waiver of such plan), for eligible individuals who are diagnosed with or presumed to have 
COVID-19, during the period such an individual has (or is presumed to have) COVID-19. 
 
Under the ARP, these coverage requirements end on the last day of the first calendar quarter that 
                                                      
4 https://www.whitehouse.gov/briefing-room/legislation/2023/04/10/bill-signed-h-j-res-7/ 
5 https://www.medicaid.gov/federal-policy-guidance/downloads/sho23002.pdf. For all CMCS unwinding resources, please visit 
https://medicaid.gov/unwinding.  
6 Previous CMS guidance on Sections 9811 and 9821 of the ARP: https://www.medicaid.gov/federal-policy-
guidance/downloads/sho22002.pdf, https://www.medicaid.gov/state-resource-center/downloads/covid-19-vaccine-toolkit.pdf, 
https://www.medicaid.gov/federal-policy-guidance/downloads/sho102221.pdf, https://www.medicaid.gov/federal-policy-
guidance/downloads/sho-21-004.pdf, https://www.medicaid.gov/federal-policy-guidance/downloads/sho-21-003.pdf,.   Page 3  CMCS Informational Bulletin 
 
begins one year after the last day of the COVID-19 PHE. If the COVID-19 PHE ends as 
expected on May 11, 2023, this ARP coverage requirement will end on September 30, 2024. 
 
ARP Section 9811 and Section 9821: Enhanced Federal Matching Funds for COVID-19 
Vaccines and Vaccine Administration 
The ARP authorizes a 100 percent FMAP for state expenditures for medical assistance for 
COVID-19 vaccines and their administration. This 100 percent FMAP ends on the last day of the 
first quarter that begins one year after the last day of the COVID-19 PHE. If the COVID-19 PHE 
ends on May 11, 2023, this 100 percent FMAP will end on September 30, 2024. 
 
Optional COVID-19 Group for Uninsured Individuals 
Section 6004 of the FFCRA provided states with the authority to provide coverage to a new 
optional COVID-19 Medicaid eligibility group (optional COVID-19 group) for uninsured 
individuals, and gave states a 100 percent federal match rate for their expenditures on medical 
assistance for this group and for their administrative costs related to providing medical assistance 
to this group. In order to be eligible for this group, an individual must be an uninsured 
individual as defined in section 1902(ss) of the Social Security Act. The FFCRA authorized 
states to provide coverage of COVID-19 testing (and related services) to this group, and the ARP 
broadened this groups coverage to also include, effective March 11, 2021, COVID-19 
vaccinations, testing, and treatment (including treatment of a condition that may seriously 
complicate the treatment of COVID-19, as described above).  
 
As of the publication date of this CIB, 15 states and three territories have opted to provide 
coverage to the optional COVID-19 group.7 For those states and territories that have adopted the 
optional COVID-19 group, the coverage (and related federal matching funds) expire on the last 
day of the COVID-19 PHE, expected to be May 11, 2023.8  
Telehealth Flexibilities 
 
Telehealth flexibilities under Medicaid and CHIP are not tied to the COVID-19 PHE. The 
flexibility to cover Medicaid and CHIP services when they are delivered via telehealth was 
available prior to the COVID-19 PHE and will continue to be available after the COVID-19 PHE 
ends. CMCS encourages states to continue to cover Medicaid and CHIP services when they are 
delivered via telehealth.  
 
States have a great deal of flexibility with respect to covering Medicaid and CHIP services 
provided via telehealth. Generally, a state does not need to submit a State plan amendment (SPA) 
to the Centers for Medicare & Medicaid Services (CMS) to describe when it will cover or pay 
for already-covered Medicaid services when they are delivered via telehealth, unless it wants to 
cover or pay for the services differently when the services are delivered via telehealth.9 States 
have the option to determine whether (or not) to cover Medicaid and CHIP services when they 
                                                      
7 Fifteen states have taken up the option: California, Colorado, Connecticut, Iowa, Illinois, Louisiana, Maine, Minnesota, North 
Carolina, New Hampshire, New Mexico, Nevada, South Carolina, Utah, and West Virginia. Three territories have taken up this 
option: the Commonwealth of the Northern Mariana Islands, Puerto Rico, and the United States Virgin Islands. 
8 For more information on the optional COVID-19 group: https://www.medicaid.gov/resources-for-states/downloads/ending-
covrg-optnl-covid-grp-guidance.pdf.  
9 For more information on when a SPA might be necessary, see 
https://www.medicaid.gov/medicaid/benefits/downloads/medicaid-chip-telehealth-toolkit.pdf.     Page 4  CMCS Informational Bulletin 
 
are delivered via telehealth. For example, states have flexibility to determine what types of 
services are covered when delivered via telehealth, where in the state coverage of services 
delivered via telehealth is available, and which telehealth modalities may be used to deliver 
covered services. 
 
To assist states with the continuation, adoption, or expansion of telehealth coverage and payment 
policies, CMCS has released the State Medicaid & CHIP Telehealth Toolkit10 and a supplement 
that identifies for states the policy topics that should be addressed in order to facilitate 
widespread adoption of telehealth. 
 
The Implications of the End of the COVID-19 National Emergency for Section 1135 
Waivers  
 
CMS has the authority to temporarily modify or waive certain Medicaid and CHIP requirements 
under section 1135 of the Social Security Act when 1) the President declares a state of 
emergency under the Stafford Act or the National Emergencies Act, and 2) the Secretary also 
declares a public health emergency (PHE) under section 319 of the PHS Act. As discussed 
above, a joint resolution of Congress was signed into law by the President on April 10, 2023 that 
ended the COVID-19 National Emergency declared by the President, effective immediately. 
Again, the COVID-19 National Emergency is separate from the COVID-19 PHE, which is 
expected to remain in effect until May 11, 2023.  
 
The end of the COVID-19 National Emergency on April 10, 2023 ended CMSs authority to 
issue new, prospective section 1135 waivers related to the COVID-19 pandemic. Any section 
1135 waivers currently in effect for the COVID-19 pandemic and approved prior to April 10, 
2023 remain in effect until the end date of the COVID-19 PHE, or earlier, as determined by 
CMS.  
 
Since 2020, states submitting a Medicaid Disaster Relief SPA for COVID-19 have been able to 
request section 1135 waivers or modifications of the federal SPA effective date, public notice, 
and Tribal consultation requirements applicable to the SPA submission. The end of the COVID-
19 National Emergency has the following implications for states submitting Medicaid Disaster 
Relief SPAs related to the COVID-19 pandemic:  
 
  Section 1135 waivers to waive or modify SPA submission requirements apply to the 
submission date of the Medicaid Disaster Relief SPA. Therefore, the section 1135 waiver 
authority to waive or modify SPA submission requirements for Medicaid Disaster Relief 
SPAs submitted on or after April 10, 2023 is no longer available.   
 
  If a state requested a section 1135 waiver or modification of these SPA submission 
requirements in connection with a Medicaid Disaster Relief SPA that was submitted prior 
to April 10, 2023, CMS can still approve the section 1135 request, because the section 
1135 waiver or modification would relate to a date prior to April 10, 2023. 
 
                                                      
10 https://www.medicaid.gov/medicaid/benefits/downloads/medicaid-chip-telehealth-toolkit.pdf and 
https://www.medicaid.gov/medicaid/benefits/downloads/medicaid-chip-telehealth-toolkit-supplement1.pdf.    Page 5  CMCS Informational Bulletin 
 
  However, any Medicaid Disaster Relief SPAs related to the COVID-19 pandemic 
submitted on or after April 10, 2023 must comply with the usual SPA effective date, 
public notice, and Tribal consultation requirements, because a section 1135 waiver or 
modification of those SPA submission requirements is no longer available for dates on or 
after April 10, 2023. 
 
  This change to the availability of section 1135 waivers related to Medicaid Disaster 
Relief SPA submissions does not affect the end date for these SPAs. Medicaid Disaster 
Relief SPAs related to the COVID-19 pandemic can remain in effect until the end of the 
COVID-19 PHE, unless the state specifically tied the end date of the SPA to the end of 
the COVID-19 National Emergency or otherwise specified an earlier end date.  
Closing 
 
CMCS encourages states to review their policies, systems, and procedures to ensure compliance 
with changes expected as a result of the end of the COVID-19 PHE. As CMCS has 
recommended in prior guidance,11 states should also communicate with providers and enrollees 
where appropriate to advise them about the end of flexibilities. As states assess flexibilities 
adopted during the COVID-19 PHE, CMCS continues to be available to provide states with 
technical assistance as they prepare for the end of the COVID-19 PHE. For any questions or 
additional technical assistance, states may contact their CMCS State Lead.  
 
   
                                                      
11 State Health Official Letter: Planning for the Resumption of Normal State Medicaid, Childrens Health Insurance Program 
(CHIP), and Basic Health Program (BHP) Operations Upon Conclusion of the COVID-19 Public Health Emergency, December, 
22, 2020: https://www.medicaid.gov/federal-policy-guidance/downloads/sho20004.pdf   Page 6  CMCS Informational Bulletin 
 
Appendix 
 
Key Dates for Expiration of Medicaid and CHIP COVID-19 Flexibilities and Requirements 
 
Each temporary flexibility adopted by states to respond to the COVID-19 PHE is scheduled to 
sunset either upon expiration of the COVID-19 PHE or another specified date. Certain COVID-
19 coverage requirements are also temporary. The expiration dates for various flexibilities and 
requirements are provided in the table below.  
 
For more information about Medicaid and CHIP flexibilities and requirements and the end of the 
COVID-19 PHE, please see the February 2023 All-State Call Presentation Preparing to Resume 
to Normal Operations: End of PHE Impact on Medicaid and CHIP Flexibilities.12 
 
  Authority/Provision  Expiration Date13 
1  Medicaid Disaster State Plan    Expires at the end of the COVID-19 PHE (May 
Amendment (SPA)  11, 2023) or any earlier approved date elected by 
state. 
2  CHIP Disaster SPA    COVID-19 PHE SPA: Expires at the end of the 
COVID-19 PHE (May 11, 2023). 
  Evergreen Disaster SPA: Expires the later of the 
state-declared emergency or the end of the 
COVID-19 PHE (May 11, 2023), or as otherwise 
specified in the SPA. 
  Both SPA types may also expire at any earlier 
date, at state discretion. 
3  Home and Community-Based Services    Expires no later than six months after the 
(HCBS) Appendix K/ Attachment K  expiration of the COVID-19 PHE (November 11, 
2023). This could be an earlier date if requested 
by the state and approved by CMCS. 
4  Medicaid & CHIP 1135 Waivers    Expires at the end of the COVID-19 PHE (May 
11, 2023). 
5  Section 1115 COVID-19 Demonstration    Expires no later than 60 days after the end of the 
COVID-19 PHE (July 11, 2023) unless 
otherwise noted in section 1115 demonstration 
approval documents. 
6  Optional COVID-19 Group    Authority to provide coverage to this group 
expires at the end of the COVID-19 PHE (May 
11, 2023). 
  No federal financial participation is available for 
any state expenditure associated with medical 
assistance services or administrative costs for 
this group, including coverage of COVID-19 
vaccinations, testing, and treatment, after the 
COVID-19 PHE ends. 
                                                      
12 https://www.medicaid.gov/resources-for-states/downloads/covid19allstatecall02142023.pdf  
13 Expiration dates are based on the expected May 11, 2023 expiration of the COVID-19 PHE.  Page 7  CMCS Informational Bulletin 
 
  Authority/Provision  Expiration Date13 
7  ARP Mandatory Medicaid & CHIP    Ends on the last day of the first calendar quarter 
Coverage of COVID-19 Vaccinations,  that begins one year after the last day of the 
Testing, and Treatment Without Cost  COVID-19 PHE (September 30, 2024). 
Sharing  
8  Increased FMAP and eFMAP for    Ends on the last day of the first quarter that 
Medicaid & CHIP Coverage for  begins one year after the last day of the COVID-
COVID-19 Vaccines and Vaccine  19 PHE (September 30, 2024). 
Administration   
9  Medicaid and CHIP Disaster Relief    Ends on the date specified in the Medicaid and 
MAGI-Based Verification Plan  CHIP Disaster Relief MAGI-Based Verification 
Addendum  Plan Addendum in each applicable state.