The COVID-19 pandemic and federal Public Health Emergency (PHE) declaration introduced many temporary flexibilities for states’ Medicaid programs. Chief among these was the “continuous coverage” provision, which required states to maintain enrollment of nearly all those covered by Medicaid health insurance from March 2020 through the end of the PHE.

This provision led to record national Medicaid enrollment, and reduced the national uninsured rate to its lowest point in history (8%). Nationally, more than 90 million individuals are enrolled in either Medicaid or the Children’s Health Insurance Program (CHIP, known as FAMIS in Virginia). Virginia’s enrollment has reached an historic peak, too: As of March 1, 2023, 2.2 million Virginians were enrolled in Medicaid/FAMIS.

In December 2022, Congress took action requiring all states to resume conducting Medicaid eligibility renewals – and, terminating coverage for those no longer found to qualify – beginning April 1, 2023.

All states are now faced with the monumental task of returning their Medicaid programs to normal renewal operations, after 3 years of having paused them. It will be the largest single enrollment event in Medicaid history, and will take a full year. This resumption of eligibility renewals has been referred to as “unwinding” of the Medicaid continuous coverage.

Two conditions may cause an individual to lose Medicaid coverage at renewal:

The U.S. Department of Health and Human Services Assistant Secretary for Planning and Evaluation (ASPE) projects that 17.4% of those currently covered by Medicaid are likely to lose their coverage at renewal (9.5% due to no longer meeting eligibility criteria, and 7.9% for administrative reasons).

Virginia’s Department of Medical Assistance Services (DMAS) estimates that 14 – 17% of Virginians enrolled in Medicaid/FAMIS (roughly 308,000 – 374,000) will likely lose coverage for either eligibility or administrative reasons. 

Virginia will use a “time-based” approach to process renewals, wherein the oldest overdue renewals will be processed first (e.g., those that were originally due in March 2020), with others processed on a staggered schedule in descending order during a yearlong period. This means some Virginians may receive a renewal packet as early as March 2023, while others will receive a packet at different points throughout 2023 through mid-2024.

This staggered approach is designed to avoid overwhelming the agencies which are responsible for processing renewals. Most enrollees will keep their new renewal dates from one year to the next, so this staggered approach will also help to ensure an even distribution of workload in future years.

Some Medicaid enrollees will be renewed automatically. Enrollees who are under 65 years old, and whose income and household information is already known to the state, are more likely to have their coverage renewed automatically via this “ex parte” approach. Those whose automatic renewal is successful should receive a notice from the state alerting them that their coverage will continue for an additional year. These automatic renewals will occur on a staggered schedule, as well.

Most enrollees, however, will need to take action to renew. They will receive a prepopulated renewal packet via mail, from their local Department of Social Services (DSS). Enrollees should check their mail daily, and open the renewal packet right away. They will have 30 days to complete and return their renewal as soon as possible, by the specified due date. Enrollees who do not renew by the deadline will receive a termination notice, but will get a brief grace period (90 days) in which they can re-enroll in Medicaid retroactive to the date of their termination.

Responding as soon as possible helps ensure continuity of coverage. They can complete the renewal:

Virginia will not terminate an enrollee’s coverage without reaching out to request updated information first. The state plans to take special additional steps to ensure that renewal notices and other key correspondence reach enrollees, including those who moved throughout the pandemic. These include:

National projections from The Urban Institute suggest that many of those who are no longer eligible for Medicaid will be able to transition to another type of coverage. This includes those who will enroll in Employer-Sponsored Insurance (ESI), nongroup coverage (including coverage through the Health Insurance Marketplace), or other public coverage (including Medicare):

Source: Buettgens, M. and Green, A. The Impact of the COVID-19 Public Health Emergency on All Types of Health Coverage. The Urban Institute (December 2022), using its Health Insurance Policy Simulation Model.

Recent federal changes have increased the amount of financial help available through the Health Insurance Marketplace, making it possible for many Marketplace customers to pay nothing for a generous Silver-level plan with minimal cost-sharing. ASPE estimates that more than 2.7 million individuals who lose Medicaid will be eligible for this financial help. The Marketplace has also created a Special Enrollment Period for those who lose Medicaid coverage, so they can sign up for health insurance from the Marketplace at any time from March 2023 – July 2024.

Marketplace options in Virginia now include more coverage choices than ever before, with all localities having at least 2 insurers to choose from. For one-on-one help evaluating options on the Marketplace, Virginians can find a local ENROLL Virginia! Navigator at enrollva.org/get-help/.

Despite best efforts to promote the need to renew eligibility, it is expected that some Virginians still eligible will lose their Medicaid coverage. This could happen because they didn’t receive the renewal package, didn’t provide all needed information, or there was a glitch of some sort somewhere in the process.

DMAS estimates that 4% of Virginians enrolled in Medicaid will lose Medicaid during the first year of renewals (equates to nearly 88,000 people), and return to Medicaid within a year or less. This “administrative loss of coverage” can result in lapse in treatment, inability to obtain needed medicines, and incurrence of medical debt for patients. Health professionals, hospitals, and health systems may also see decreases in revenue, as Medicaid-eligible-but-unenrolled patients are unable to pay for their visits due to having lost their coverage.

This “churn” off and back onto coverage is costly from a human and economic perspective. Awareness about the resumption of Medicaid renewals, familiarity with general Medicaid eligibility criteria, and understanding of the 90-day grace period will be critical to reducing administrative churn among key vulnerable populations.

The U.S. Department of Health and Human Services estimates that a disproportionate number of children and people of color are likely to be disproportionately disenrolled administratively, as states resume Medicaid renewals. Children are expected to represent more than 50% of those who lose coverage for administrative reasons. Latinos and Blacks are projected to account for one-third and 15%, respectively, of those who are eligible, but lose coverage.

These national projections do not have to be the reality in Virginia! Communication and raising awareness is critical to keeping those eligible enrolled. Community-based organizations, houses of worship, and friends and neighbors have an opportunity to help keep eligible Virginians covered, by sharing information about renewals and what Virginians need to do to keep their Medicaid health insurance. Organizations can disseminate information about Medicaid renewals resuming via their newsletters, websites, social media accounts, community gatherings, and one-on-one discussions with clients. Congregations can include notices in worship bulletins and at their events. Local governments can share the information at public meetings, online, and in utilities bills. Individuals can spread the word in conversations with neighbors, co-workers, and family and friends at picnics, parties, and gatherings of all sorts.

1. Update your contact information with Virginia Medicaid.

Medicaid/FAMIS enrollees’ contact information must be kept up-to-date, so they can receive mailed correspondence from the state about their Medicaid/FAMIS renewal at the appropriate time. Those who live, work, play, help, or worship with Medicaid/FAMIS enrollees can help now by encouraging those who have moved or changed phone numbers since 2019 to report these important changes:

2. Watch for a renewal notice via mail from your local Department of Social Services.

3. Open the renewal notice and respond by the due date or sooner.

Medicaid/FAMIS enrollees should read these notices and respond as instructed to help ensure their Medicaid/FAMIS coverage can continue, if they are still eligible.

The more a person hears a message, the more likely s/he is to remember it. Virginians enrolled in Medicaid, especially those most vulnerable to losing their coverage, can’t hear these key messages too many times.

To help make it easy for organizations, congregations, and individuals to convey these messages, DMAS has developed digital communications Tool Kits, social media graphics, and printable designs. Sample newsletter text and other messaging materials from these Tool Kits make it easy to share the news.

Organizations and individuals who want to help those in their communities enroll in and renew Medicaid/FAMIS coverage can familiarize themselves with eligibility basics and enrollment/renewal policies and procedures at a SignUpNow workshop conducted by the Virginia Health Care Foundation:

They can also connect those who need one-on-one help applying for or renewing Medicaid/FAMIS to a local Project Connect application assister, who is specially trained to help individuals and families apply for, enroll in, and renew eligibility for Virginia’s Medicaid/FAMIS programs. Project Connect application assisters can also help individuals/families who are no longer eligible for Medicaid/FAMIS find local resources to evaluate their coverage options on the Marketplace.

Virginia’s Departments of Medical Assistance Services and Social Services have worked diligently to prepare for the resumption of Medicaid renewals. Eligibility systems have been modernized to maximize the number of renewals that are completed automatically, and to better enable the state to process the remainder expeditiously.

Local DSS agencies and the state’s Cover Virginia Call Center have ramped up staffing and staff training regimens, in anticipation of the volume of Virginians who will need to renew or have questions about renewals.

DMAS has convened and solicited feedback from a Stakeholder Task Force. It hosted a Medicaid Renewals Summit to prepare 300 stakeholders, and a series of virtual town hall-style meetings targeting key stakeholder subgroups (including community advocates and healthcare providers). DMAS is also working closely with Virginia’s Medicaid/FAMIS Managed Care Organizations to acquire enrollees’ updated contact information, and reach out to enrollees via multiple methods (e.g., text or email).

DMAS is committed to transparency. It will share key data about renewals via a monthly dashboard on its website.

Within the next 12 months, 2.2 million Virginians – roughly a quarter of the state’s population – will need to renew their Medicaid/FAMIS health insurance. For many, including the more than 730,000 adults enrolled since Virginia made coverage available to them in 2019, this will be their first ever Medicaid renewal. For others, this will be the first time they have renewed in 3 years.

An “all-hands-on-deck” approach will be required to ensure that eligible Virginians remain enrolled, and that Virginians who are no longer eligible transition successfully to other health insurance. What will you and your organization do to help?