This expert perspective summarizes a recent federal court ruling that impacted the Centers for Medicare & Medicaid Services’ (CMS) enforcement of an interim final rule (IFR) that narrowed CMS’ interpretation of the Medicaid continuous coverage requirement in the Families First Coronavirus Response Act (FFCRA). In November 2022, a federal court in Connecticut ruled in Carr v. Becerra that CMS had acted impermissibly by issuing the IRF in November 2020. On January 31, 2023, the court broadened its order to include all Medicaid enrollees nationwide who had experienced a reduction in Medicaid benefits due to the IFR. The expert perspective discusses potential implications for states and enrollees.

As a result of the Consolidated Appropriations Act, 2023 (CAA), states can start refining and implementing long laid plans to restart eligibility redeterminations and return to routine eligibility and enrollment operations. As part of this process, states will be required to closely track and monitor the impacts of the resumption of eligibility redeterminations and disenrollments and to make that data public. This expert perspective outlines the relevant reporting requirements that were included in the CAA and the corresponding reporting guidance provided by CMS in its January 2023 State Health Official letter, and presents considerations for state officials.

On January 27, 2023, the Centers for Medicare & Medicaid Services released a State Health Official (SHO) 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.” The SHO letter is the second in a series of guidance related to section 5131 of the Consolidated Appropriations Act, 2023 (CAA), which established a fixed end date for the Medicaid continuous coverage requirement, a gradual phase-down for the enhanced federal match, and new guardrails for mitigating coverage loss for individuals who continue to be eligible. This expert perspective reviews the additional detail and operational expectations of states during the unwinding of Medicaid continuous coverage as laid out in the SHO letter.

State updates as of February 3, 2023.

On January 26, 2023, the Centers for Medicare & Medicaid Services approved California’s request to amend the California Advancing and Innovating Medi-Cal Section 1115 demonstration. This expert perspective describes the amendment, a centerpiece of which is approval for California Medicaid to provide a targeted set of Medicaid services to youth and adults in state prisons, county jails, and youth correctional facilities for up to 90 days prior to release. By providing reentry services to Medicaid-enrolled individuals who are incarcerated, California aims to build a bridge to community-based care for justice-involved enrollees, offering them services to stabilize their physical and behavioral health conditions and establishing, prior to release, a reentry plan for their community-based care.

On January 23, 2023, the Federal Communications Commission issued an important ruling that provides states with new flexibility to support enrollee outreach and communication efforts as part of their processes to unwind the Medicaid continuous coverage requirement. The ruling permits state agencies and their partners to send text messages and make phone calls to individuals about enrollment-related issues not only for Medicaid but for other state-run health insurance programs, including marketplace coverage. This expert perspective reviews the ruling and implications for states.

State updates as of January 27, 2023.

State updates as of January 20, 2023.

State updates as of January 13, 2023.

The Centers for Medicare & Medicaid Services recently released a State Medicaid Director Letter on how states can use “in lieu of” (ILOS) services authority, including to address social drivers of health. The letter establishes the requirements and guardrails states must meet to ensure the use of ILOS are cost effective, medically appropriate, preserve enrollee rights and protections, and fulfill the objectives of the Medicaid program. This expert perspective provides a summary of the guidance.