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Medicaid and Children’s Health Insurance Program (CHIP) COVID-19 Public Health Emergency Continuous Enrollment Unwinding

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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.

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 (PDF | 1.7 MB) and a toolkit in Spanish (PDF | 1.9 MB).

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.
  • 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.
  • 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 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.

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
Assistant Secretary for Mental Health and Substance Use

SAMHSA Unwinding Letter (PDF | 320 KB)


1The 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.

Last Updated

Last Updated: 07/19/2022