www.samhsa.gov • 

∙

June 16, 2022 

To: Substance Abuse and Mental Health Services Administration (SAMHSA) 

Grantees 

Subject: Medicaid and Children’s Health Insurance Program (CHIP) COVID-19 Public 

Health Emergency Continuous Enrollment Unwinding – Implications for 

Individuals Receiving Medicaid and CHIP 

Dear SAMHSA Partner: 

Every day you foster skills and provide resources to individuals living with mental and 

substance use disorders and their families, including when they face unexpected challenges. 

This work has never been more critical than during the COVID-19 pandemic. We thank you 

for your partnership and your leadership during this difficult time. 

Although pandemic conditions are improving in some places, SAMHSA recognizes that many 

communities across the nation are still impacted by COVID-19. Over the past two years, the 

U.S. Department of Health and Human Services issued, and renewed, a public health 

emergency (PHE) declaration. While we do not yet know when the PHE will end, SAMHSA 

understands that when the PHE does wind down, so too will the waivers and flexibilities tied 

to it. Our trusted community partners will be a vital part of helping families, individuals, and 

communities become informed and take action to maintain important benefits and services 

they may be eligible for. 

I am writing today because SAMHSA is committed to providing guidance and technical 

assistance throughout the PHE unwinding process.1 

We know Medicaid and CHIP serve many of your program participants. The Families First 

Coronavirus Response Act (FFCRA), passed by Congress in March 2020, prohibited states 

from disenrolling individuals from Medicaid for the duration of the PHE as a condition of 

accessing enhanced Medicaid funding. Many states adopted similar options in CHIP. 

1

The federal government issued the first PHE in January 2020, amid deteriorating public health conditions. Enabled by the PHE 

and subsequent Congressional action, HHS made swift and significant changes to how its programs operate to ensure the 

continuous delivery of services and the financial viability of entities providing these services. A PHE is for 90 days and must be 

continuously renewed. The current PHE is set to expire on July 15th. The possibility exists for HHS to renew the PHE again, and 

the Administration has committed to providing a 60-day notice of the expiration. Until that time, the waivers and flexibilities will 

remain in place, and current program requirements will remain the same. 

Behavioral Health is Essential to Health • Prevention Works • Treatment is Effective • People Recover
 

 

 

 

 

 

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The Biden-Harris Administration has committed to provide states 60 days of notice before 

any planned expiration or termination of the PHE. In the interim, the Centers for Medicare & 

Medicaid Services (CMS) will be communicating regularly with partners to support planning 

and coordination during the unwinding process to help ensure people enrolled in Medicaid 

and CHIP maintain a source of health care coverage. 

This communication explains what this means for Medicaid and CHIP enrollment, and how 

you can help families in danger of losing health care coverage. 

Impacts to Medicaid and CHIP 

To comply with the continuous enrollment requirement in the FFCRA, state Medicaid 

agencies have not terminated ineligible individuals since early 2020. This helped prevent 

people with Medicaid and CHIP from losing health care coverage during the pandemic. 

Because of FFCRA and the effects of the pandemic, Medicaid and CHIP enrollment grew by 

more than 16 million, allowing record high levels of children and families to preserve access 

to health care – nearly 87 million as of January 2022. 

When the PHE expires, states will complete eligibility renewals for most individuals in 

Medicaid and CHIP for the first time since March 2020. Given that significant time may 

have elapsed since families were last required to renew, states may have outdated 

contact information for a substantial number of program enrollees. Almost 15 million 

enrollees, including children, young adults, and other vulnerable populations, could be at risk 

of losing Medicaid or CHIP coverage, though many may be eligible for other coverage 

options, including through the Health Insurance Marketplace. 

Strategies to Reach Families and Individuals 

We ask for your assistance with sharing key messages to prepare people you serve to 

renew their coverage. Families and individuals should: 

• Update their contact information with their state Medicaid program or CHIP, 

• Check their mail for a renewal form and complete and submit the form in a timely 

manner. 

You can find assistance with these key messages in a Medicaid and CHIP Continuous 

Enrollment Unwinding – Toolkit in English here and a toolkit in Spanish here. 

In addition, we encourage you, to the extent possible, to consider the following examples of 

how you can share this information with families: 

• Train all front-line staff and ensure they are knowledgeable on steps families can take to 

renew their health care coverage. 

• Share key information on Medicaid and CHIP renewal as part of your application intake 

or renewal process for other programs. 

Substance Abuse and Mental Health Services Administration 

1-877-SAMHSA-7 (1-877-726-4727) • 1-800-487-4889 (TDD) • www.samhsa.gov 
 

 

 

 

 

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• States may use information from other programs like Supplemental Nutrition Assistance 

Program (SNAP) and Temporary Assistance for Needy Families (TANF) to verify 

eligibility and facilitate renewals, though some actions will require a state plan 

amendment. 

• CMS encourages states to set a renewal schedule that spreads renewal volume over a full 

12-month period and aligns renewal dates for individuals within households and with 

recertification timing for the SNAP and other human services programs. 

• Promote Medicaid and CHIP renewal on your websites, social media channels, and in 

your physical offices. You can access Medicaid Unwinding Toolkit graphics in English 

and Spanish here. 

• Ensure that families know if they are no longer eligible for Medicaid and CHIP, they may 

be eligible for the Health Insurance Marketplace. You can direct them to or help them 

visit HealthCare.gov or you can call the Marketplace Call Center at 1-800-318-2596 

(TTY: 1-855-889-4325) to get details about Marketplace coverage. 

Additional CMS Resources 

Starting May 25, CMS will host a monthly partner education series on Medicaid and CHIP 

Continuous Enrollment Unwinding. The first call provided background information on the 

Medicaid continuous enrollment requirements, efforts underway to connect people to 

coverage, discuss strategies to engage people with Medicaid & CHIP, and reviewed resources 

currently available for partners to begin sharing information on preparing for the Medicaid 

and CHIP redetermination process with your audiences. You can register for the webinar 

series here or email your questions to PARTNERSHIP@cms.hhs.gov. 

CMS has also created a resource page, https://www.medicaid.gov/unwinding, to help states 

and territories access guidance, communications materials, and other tools related to returning 

Medicaid and CHIP to normal operations. You can find a list of outreach strategies for state 

Medicaid agencies in Appendix B of Promoting Continuity of Coverage and Distributing 

Eligibility and Enrollment Workload in Medicaid, the Children’s Health Insurance Program 

(CHIP), and Basic Health Program (BHP) Upon Conclusion of the COVID-19 Public Health 

Emergency located on the resource page. 

On May 23, CMS launched a second resource page, https://www.medicaid.gov/renewals. It 

provides information to help beneficiaries get ready to renew their coverage, including 

updating contact information, checking their mail, and completing a renewal form, if needed. 

The page also provides an interactive map to easily connect beneficiaries directly to their state 

Medicaid agency. We encourage you to visit both sites and support continuous enrollment in 

affordable health coverage for individuals living with mental and substance use disorders, and 

their families. 

Substance Abuse and Mental Health Services Administration 

1-877-SAMHSA-7 (1-877-726-4727) • 1-800-487-4889 (TDD) • www.samhsa.gov 
 

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SAMHSA is committed to providing timely guidance and resources as our partners navigate 

impacts to programs and service delivery when the national PHE winds down. We know your 

direct relationships and communication with families and individuals are critical. 

Thank you for your continued collaboration to advance the behavioral health of the nation. 

Sincerely, 

/Miriam Delphin-Rittmon/

Miriam Delphin-Rittmon 

Assistant Secretary for Mental Health 

and Substance Use 

Substance Abuse and Mental Health Services Administration 

1-877-SAMHSA-7 (1-877-726-4727) • 1-800-487-4889 (TDD) • www.samhsa.gov