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U.S. Department of Health and Human Services
Division of Business Office Enhancement

Medicaid Unwinding

What is Medicaid Unwinding?

Medicaid Exit Disclaimer: You Are Leaving www.ihs.gov  and the Children’s Health Insurance Program Exit Disclaimer: You Are Leaving www.ihs.gov  play critical roles in helping states and territories respond to public health emergencies and disasters, including the outbreak of COVID-19. Over the course of the COVID-19 Public Health Emergency, state Medicaid, CHIP, and Basic Health Programs adopted many flexibilities offered by the Centers for Medicare & Medicaid Services Exit Disclaimer: You Are Leaving www.ihs.gov  to respond effectively to their local outbreaks.

Medicaid and the Children’s Health Insurance Program will soon start to return to normal operations. States could begin to send renewal letters in February and beginning April 1, 2023, in some states, individuals will lose their coverage if they are no longer eligible. To avoid an interruption in coverage, Medicaid recipients should update their contact information with their state Medicaid or CHIP program. Medicaid recipients should also look out for a letter from their state about completing a renewal form.

Frequently Asked Questions

When will the Medicaid Unwinding begin?

On December 29, 2022, the Consolidated Appropriations Act, 2023 was enacted. This law includes various Medicaid and Children’s Health Insurance Program provisions, including significant changes to the continuous enrollment condition. The continuous enrollment condition will end on March 31, 2023 and states must, over time, return to normal eligibility and enrollment operations. Some states will be able to terminate Medicaid enrollment for individuals no longer eligible beginning April 1, 2023.

What actions should American Indians and Alaska Natives take to avoid an interruption in coverage?

American Indians and Alaska Natives with Medicaid or CHIP coverage should:

  1. Update their contact information with their State Medicaid or CHIP program; and
  2. Look out for a letter from their state about completing a renewal form.

How can staff from IHS, tribal and urban Indian facilities assist American Indians and Alaska Natives beneficiaries?

Step 1: Plan, learn, and understand state timeframes and processes.

  • States are setting timeframes and processes for the full renewal processes.
  • ITUs should track state plans and provide feedback.
  • ITUs should include staff that assist with patient benefits coordination.
  • States and ITUs should consider data sharing agreements.


Step 2: Conduct outreach to Medicaid enrollees to prepare for renewals.

  • Begin outreach and messaging campaigns regarding:
    • The state plan for the renewal process and how and when they will have to take action.
    • The need to give states their best contact information.
  • Ensure staff are available to assist individuals to submit updated contact information to the state Medicaid agency.
  • Use available IHS, CMS, and state communications strategies, processes, and tools for use with Medicaid enrollees.
  • Plan for mail delays due to the unique nature of receiving mail in Indian Country.


Step 3: Assist in the renewal process once it begins.

  • Ensure adequate capacity and training for enrollment assisters.
  • Help Medicaid eligible individuals complete and submit renewal forms and required documents.
  • Help American Indians and Alaska Natives who lost eligibility due to non-submission of renewal forms to complete the reinstatement process.
  • Help American Indians and Alaska Natives ineligible for Medicaid apply for Marketplace or other coverage.

What resources are available?