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Medicaid Unwinding

**HHS Reminds States of Legal Obligations to Federal Civil Rights Protections as States Transition from Medicaid Continuous Coverage Changes as the Public Health Emergency Ends – April 5, 2023**

OCR has issued a letter, reminding states of their obligations under federal civil rights laws as the Public Health Emergency for COVID-19 and the continuous Medicaid coverage comes to an end, and states restart Medicaid and Children’s Health Insurance Program (CHIP) eligibility reviews.  The Families First Coronavirus Response Act (FFCRA) allowed for continuous Medicaid and CHIP coverage during the COVID-19 Public Health Emergency.  The expiration of this requirement presents the single largest health coverage transition event since the first open enrollment period of the Affordable Care Act.  As a result of the Consolidated Appropriations Act, 2023, this continuous enrollment condition ended March 31, 2023; states must, over time, return to normal eligibility and enrollment operations, in a process referred to as “unwinding.” As states begin unwinding, they are communicating with individuals and families to receive more information to make a coverage decision, provide information on eligibility and marketplace plans, and send people a renewal letter in the mail. Most children can still be covered through the Children’s Health Insurance Program.  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 Children’s Health Insurance Program coverage upon the expiration of the FFCRA continuous enrollment condition.

Read the Letter
	Read the Press ReleaseOCR Resources

OCR signs effective communication Dear Colleague Letter with the Health Resources and Services Administration (08/30/2016)
	Read the Bulletin
		Read the Letter
		En Español
	OCR signs effective communication Dear Colleague Letter with the Puerto Rico Hospital Association. (06/09/2015)
	Read the Bulletin
		Read the Letter
		En Español (Spanish)
	Auxiliary Aids and Services for Persons with Disabilities  – Sample policy and procedures for providing effective communication.
	Chart for Sign Language Interpreters Chart – Sample notification list for providing information about staff interpreter and outsider interpreter services. (PDF document)
	Civil Rights Clearance for Medicare Provider Certification – Technical assistance, forms, guidance, and educational materials and resources to assist Medicare Providers and Provider Applicants.
	HIPAA Privacy Rule FAQs: Medical Privacy and Telecommunications Relay Service, Medical Privacy and Interpreters.
	Improving Patient-Provider Communications YouTube Video: Part 1 | Part 2 | Part 3 | Part 4 – A collaboration between OCR and the Joint Commission to promote language access education.Other Federal Resources

ADA.gov – Information and technical assistance on the Americans with Disabilities Act. (Department of Justice)
	ADA Business Brief: Communicating with People Who are Deaf or Hard of Hearing in Hospital Settings (the Department of Justice)
	ADA Tax Incentives Packet for Businesses – Information on federal tax credits and deductions available for businesses to help offset costs of improving accessibility for customers and employees with disabilities. (Department of Justice)
	American Sign Language (ASL) – Information from the National Institute on Deafness and Other Communication Disorders. (National Institutes of Health)
	Video Relay Service (VRS) – Consumer facts on Telecommunication Relay Service (TRS) for persons with hearing disabilities to communicate with voice telephone users. (Federal Communications Commission)**Other Organizational Resources**

External links to other sites are intended to be informational only and do not have the endorsement of HHS and OCR.

Advancing Effective Communication, Cultural Competence, & Patient-and Family-Centered Care (A Joint Commission resource site)
	Data Collection and Use: Disparities Toolkit – A web-based tool to collect race, ethnicity, and primary language data from patients. (The Health Research and Educational Trust)
	The National Association of the Deaf – Resources for communicating with deaf and hard of hearing persons, training programs, captioning agencies, commissions on the deaf and hard of hearing, community services, interpreting agencies, and telecommunications/relay businesses.

                    
  


Content created by Office for Civil Rights (OCR) Content last reviewed October 24, 2023Back to top
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