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            -                   Medicaid Renewals and Other Policy Changes due to the end of COVID-19 Flexibilities              

# Medicaid Renewals and Other Policy Changes due to the end of COVID-19 Flexibilities

*Return to ACL's COVID-19 page*

The federal Public Health Emergency (PHE) and Major Disaster Declaration (MDD) for COVID-19 ended on May 11, 2023, and federally funded programs returned to normal operations. This transition ended the temporary, but significant, changes made to Medicaid enrollment and eligibility rules, as well as additional pandemic-specific flexibilities extended to State Units on Aging for programs funded through the Older Americans Act.

As trusted community partners and effective messengers, the aging and disability networks have a critical role to play in ensuring millions of low-income older adults, people with disabilities, their families and caregivers retain health coverage.

This HHS fact sheet, released on May 9, 2023, describes flexibilities enabled by the COVID-19 emergency declaration during the PHE and they are impacted by the end of the COVID-19 PHE. on May 11.Guidance for State Units on Aging
The Aging network has met the needs of older adults and their family caregivers during the COVID-19 pandemic by providing critical Older Americans Act (OAA) services throughout this unprecedented time. Some of these services the network has been able to provide were due to the flexibilities allowed through congressional action during the PHE and MDD periods. This FAQ developed by ACL addresses the end of flexibilities for OAA formula grants to State Units on Aging (SUA) associated with the conclusion of these periods.
Medicaid Renewals Resources
At the beginning of the COVID-19 pandemic, significant changes were made to Medicaid enrollment and eligibility rules to promote continuous health insurance coverage. These changes ended on May 11, 2023. As a result, many older people and people with disabilities are at risk of losing their Medicaid coverage. Disabled people and older adults who are enrolled in Medicaid need to be aware of these changes and how they may be affected, so they can take the actions needed to maintain their health insurance coverage.

In a July 13, 2023 blog post, Acting Assistant Secretary for Aging and ACL Administrator Alison Barkoff encouraged the aging and disability networks to help get the word out to people enrolled in Medicaid that they may have to take action to remain covered and that there are steps they can take if they lose Medicaid. Here are some key messages:
- UPDATE your contact information with your state Medicaid agency NOW.
- RESPOND to the Medicaid renewal form when it comes in the mail. If you don't, you may lose your coverage even if you are still eligible.
- PARENTS should respond even if you are not eligible or are enrolled in other coverage. Your children could still be eligible for coverage.
- CONNECT WITH RESOURCES THAT CAN HELP: If you lose Medicaid coverage and think you may still be eligible, there are programs that may be able to help you appeal the denial of Medicaid coverage or find other insurance. State protection and advocacy systems and legal advocacy organizations funded under the Older Americans Act may be able to help with appeals. Disabled people of all ages can also contact the Disability Information and Access Line (DIAL) for assistance, and older adults can contact the Eldercare Locator to find local assistance.
- CHECK OTHER OPTIONS: If you are no longer eligible for Medicaid, you should check to see if you can get coverage through your employer or through the Affordable Care Act Marketplace at healthcare.gov. Older adults and people with disabilities who are eligible for Medicare can also find assistance through their State Health Insurance Assistance Program (SHIP). SHIP is a national program that offers one-on-one assistance, counseling, and education to Medicare beneficiaries of all ages, their families, and caregivers to help them make informed decisions about their care and benefits.

In addition, this March 2023 ACL blog post offers important background and details on these changes, explains how it will impact people with disabilities and older adults, and presents six things you should know about the change, along with associated action steps for the disability and aging networks.
Webinar for the aging and disability stakeholders
This September 2023 ACL webinar explored the implications of the Medicaid renewal process for older adults and people with disabilities. During the webinar, aging and disability network organizations discussed the issues that they’ve seen as Medicaid renewals restart following the end of the COVID-19 public health emergency with representatives from the Centers for Medicare & Medicaid Services (CMS). The discussion centered around topics including eligibility, enrollment, and the continuation of critical services — including home and community-based services — for people with disabilities and older adults.
Guidance on Civil Rights Protections and Language Access
On April 5, 2023, the U.S. Department of Health & Human Services Office for Civil Rights (OCR) reminded states of their obligations under federal civil rights laws as the PHE and the continuous Medicaid coverage comes to an end, and states restart Medicaid and Children’s Health Insurance Program (CHIP) eligibility reviews. The letter makes clear that states have independent obligations under federal civil rights laws to ensure that individuals and families continue to have access to Medicaid and CHIP coverage upon the expiration of the continuous enrollment condition.

On May 5, 2023 the U.S. Equal Employment Opportunity Commission (EEOC) issued a number of updates to its COVID-19 technical assistance, “What You Should Know About COVID-19 and the ADA, the Rehabilitation Act, and Other EEO Laws,” including adding a new question and answer about the end of the federal declaration of the COVID-19 public health emergency.
Resource for Grantees and Stakeholders
ACL will continue to update this page with resources to help grantees and stakeholders navigate the Medicaid renewals process.

**Resources from ACL and our Grantees:**
- Preparing for Medicaid Changes When the Public Health Emergency Expires Fact Sheet  (April 5, 2022)
- ACL's National Center on Law and Elder Rights:  Unwinding the Public Health Emergency: Strategies for Advocates to Protect Medicaid Beneficiaries  (May 2022)
- ACL's Adult Protective Services Technical Assistance Resource Center: Medicaid Unwinding:  What APS Should Know 
- The  Disability Information and Access Line (DIAL)  and the  Eldercare Locator  can help connect people with disabilities and older adults to resources available in their area.

**Resources from CMS:**
- Informational Bulletin: End of the COVID-19 Public Health Emergency (PHE) and the COVID-19 National Emergency and Implications for Medicaid and the Children’s Health Insurance Program  (May 8, 2023)
- Anticipated 2023 State Timelines for Initiating Unwinding-Related Renewals  (Updated February 24, 2023)
- Unwinding and Returning to Regular Operations after COVID-19 Resource Page
- Waivers, Flexibilities, and the Transition Forward from the COVID-19 Public Health Emergency.  COVID-19 efforts have been a significant priority for the Biden-Harris Administration  (February 27, 2023)
- Unwinding Home and Community- Based Services (HCBS) Public Health Emergency (PHE) Flexibilities  (February 8, 2023)
- Key Dates Related to the Medicaid Continuous Enrollment Condition Provisions in the Consolidated Appropriations Act  (January 5, 2023)
- Medicaid and CHIP Renewals Outreach and Educational Resources  (Includes  Training Slides for Partners to Use: What is Happening With Medicaid and the Children’s Health Insurance Program (CHIP) Right Now? )

**Additional Resources:**
- White House Fact Sheet:  Actions Taken by the Biden-⁠Harris Administration to Ensure Continued COVID-⁠19 Protections and Surge Preparedness After Public Health Emergency Transition  (May 9,2023)
- States were permitted to request flexibilities in their Home and Community-Based Services (HCBS) programs to support older adults and people with disabilities during the pandemic, including coverage of home-delivered meals or paying family caregivers. ADvancing States, the National Association of Medicaid Directors (NAMD), and the National Association of State Directors of Developmental Disabilities Services (NASDDDS)  released a new guide  to help to state Medicaid and aging and disability agencies prepare for the end of those flexibilities.
- OCR guidance on the impact of May 11 PHE expiration on HIPPA enforcement discretions
- AAHD Fact Sheet:  End of the Medicaid Continuous Coverage Requirement – What People with Disabilities Need to Know
Other Effects of the PHE Ending- Impact on CDC Activities
-  Key CDC Activities Affected by the COVID-19 PHE Expiration     - COVID Transmission Levels:  Percent positivity data, upon which the COVID Transmission Levels rely, will not be available at the county level post-PHE. COVID Transmission Levels will be sunset and removed from COVID Data Tracker on May 11.  
  - COVID-19 Community Levels (CCLs):  Due to changes in reporting requirements for case data post-May 11, CDC will no longer be able to calculate COVID-19 Community Levels (CCLs). CCLs will be sunset and removed from COVID Data Tracker on May 11. CDC will provide a new metric for people, organizations, and communities who want information on current COVID-19 risk to help their decision-making. 
  - COVID Data Tracker (CDT):  CDC will focus on weekly tracking key public health outcomes as part of an ongoing transition from the emergency phase of COVID-19 response to sustainable public health practice. The agency will prioritize tracking markers of severe illness using surveillance systems with national coverage. Phase 1 changes to CDT will launch on May 11. 
  - Genomic surveillance:  Genomic surveillance activities will continue, and data will be published on COVID Data Tracker. The laboratory data source for percent positivity, which is a statistical weighting input for model-based estimates of SARS-CoV-2 variant proportions, will be adjusted. After May 11, reporting will become bi-weekly.
  - Increasing Community Access to Testing (ICATT) Program:  CDC will continue to fund pharmacy-based testing through the ICATT program for people who are uninsured. Testing access may be reduced if fewer testing sites are enrolled and available due to insurance and reimbursement adjustments.
  - Vaccine administration data:  Receipt of vaccine administration data will be unaffected for jurisdictions with signed data use agreements (DUAs) with CDC to share data, though data completeness and submission timing may be affected. Current updates are weekly, and final update for current pages will be May 11. New COVID Data Tracker vaccine pages and visualizations are planned to launch in June as part of phase 2 updates and will be updated monthly.  Key CDC Activities Unaffected by the COVID-19 PHE Expiration    - Demographic case data:  Demographic case data will be accessible though data.cdc.gov. 
  - Long COVID:  CDC’s work on Long COVID is not affected by the end of the PHE and will continue past May 11. 
  - Sentinel surveillance:  Sentinel surveillance activities (e.g., COVID-NET) will continue past May 11, and data will continue to be published on COVID Data Tracker.
  - Traveler genomic surveillance:  Traveler genomic surveillance activities will continue past May 11, and data will continue to be published on COVID Data Tracker. After May 11, reporting will become bi-weekly. 
  - v-safe:  After May 19, those who enrolled and participated in v-safe for COVID-19 vaccines will be unable to add new COVID-19 vaccine doses to their account. Health check-ins for any doses added before May 19 will continue until June 30. CDC is developing a new version of  v-safe , launching later this year, which will allow users to share their post-vaccination experiences with new vaccines.   
  - Vaccine effectiveness:  Vaccine effectiveness activities are not tied to the PHE and will continue past May 11.
  - Wastewater surveillance:  Wastewater surveillance activities will continue past May 11, and data will continue to be published on COVID Data Tracker.  **Information/Resources on Other key (non-CDC) Activities Affected by the end of the Public Health Emergency**    - Exposure Notification System (APHL) : The Exposure Notification System will be sunset after the PHE expiration.  Exposure Notifications (aphl.org)  
  - HHS Bridge Access Program for COVID-19 Vaccines and Treatment** :  Fact Sheet: HHS Announces ‘HHS Bridge Access Program For COVID-19 Vaccines and Treatments’ to Maintain Access to COVID-19 Care for the Uninsured | HHS.gov  
  - Hospital data reporting (CMS) : Reporting of COVID-19–associated hospitalizations to the National Healthcare Safety Network will be required by CMS until April 30, 2024. After the end of the PHE, the reporting cadence will shift to weekly, and the number of data elements required to be reported will be reduced.  CMS Requirements | NHSN | CDC
  - Jurisdictional COVID-19 policies and guidance (jurisdictions) : Individual state policies may change as data reporting requirements are eliminated and states’ priorities evolve.  State COVID-19 Data and Policy Actions – Sources | KFF  (Kaiser Family Foundation state sources for all COVID-19 policies tracked) 
  - Medicaid/Medicare (CMS) :  CMS Waivers, Flexibilities, and the Transition Forward from the COVID-19 Public Health Emergency | CMS  
  - Other HHS Programs:  Fact Sheet: COVID-19 Public Health Emergency Transition Roadmap | HHS.gov    *Note this information is subject to change. CDC cannot make official statements on behalf of other USG entities or private organizations. Please refer to responsible organizations for the most up-to-date information.    **The process of transitioning to vaccine commercialization will be overseen by HHS ASPR and will not be affected by the end of the PHE. More information is available here: FAQ - Commercialization of COVID-19 Medical Countermeasures (hhs.gov); COVID-19 Vaccine Program Update to 4/19/23 ACIP Meeting; https://aspr.hhs.gov/COVID-19/Pages/FAQ-Commercialization.aspx  
- Impact on COVID-19 Testing Coverage
-  The end of the Public Health Emergency on May 11, 2023 may impact insurance coverage for laboratory and over-the-counter COVID-19 tests. This CMS fact sheet (also available in Spanish) describes how the end of the Public Health Emergency will impact testing coverage for individuals with different forms of insurance. 

*Last modified on 09/25/2023*
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