As a result of the COVID pandemic and Public Health Emergency (“PHE”), Congress enacted legislation which required states claiming an increase in the Federal Medical Assistance Percentage (“FMAP”), i.e., a temporary 6.2 percentage point increase, to implement continuous enrollment. In other words, as skilled nursing facilities likely all know, state Medicaid agencies were unable to terminate enrollment for Medicaid beneficiaries. Thus, the process entailed with the yearly renewal/redetermination of benefits was suspended. This resulted in state agencies implementing an “auto-renewal” process for Medicaid beneficiaries in lieu of the yearly renewal/redetermination of benefits.
Continuous enrollment is coming to an end as a result of new legislation enacted by Congress: the Consolidated Appropriations Act, 2023 (“CAA 2023”) and has huge implications both for Medicaid beneficiaries and skilled nursing facilities. Please note that the termination of the continuous enrollment provision is not tied to the official termination of the PHE. CMS has offered guidance relevant to the CAA 2023 and importantly guidance pertaining to the termination of the continuous enrollment provision, referred to by CMS as an “unwinding process”. The new CMS guidance highlights important dates pertaining to the termination of continuous enrollment that skilled nursing facilities should be aware of. A link to the new CMS Guidance is provided below.
Here is what you need to know:
- The continuous enrollment requirement for states will end on March 31, 2023. Beginning April 1, 2023, states will be able to terminate Medicaid enrollment for individuals determined to no longer qualify for Medicaid after conducting a renewal/redetermination giving proper notice period of same to the enrollees;
- States will have up to 12 months to initiate, and 14 months to complete a renewal/redetermination for all individuals enrolled in Medicaid;
- This March 31, 2023 termination date for the continuous enrollment provision means that states can begin their 12 month unwinding process and initiate the first Medicaid renewals/redeterminations as early as February 1, 2023 (in prior guidance, CMS indicates that states should begin renewals/redeterminations in the month before, of, or after the month in which continuous enrollment ends);
- CMS further indicates that states must initiate renewals for all Medicaid beneficiaries within 12 months, thus by March 31, 2024; and must complete renewals for all Medicaid beneficiaries within 14 months, thus by May 31, 2024;
- Despite the end of the continuous enrollment provision, states must conduct renewals/redeterminations in accordance with federal requirements to continue to receive the FMAP increase from April 1, 2023 through December 31, 2023, which is the date set by Congress for the FMAP increase to terminate;
- CMS also refers to “new, additional conditions related to conducting eligibility redeterminations” which include efforts to contact Medicaid beneficiaries. CMS states that these conditions will be addressed in forthcoming guidance.
CMS is aware of the burden both on state agencies and Medicaid beneficiaries as a result of the termination of the continuous enrollment provision, indicating that it seeks to promote continuity of coverage. However, given the length of time that the continuous enrollment provision has been in place, certain issues are likely to crop up. As we have recommended, it would be a good time to start gathering updated resource information for your residents in order to avoid any surprises with respect to excess resources that must be spent down.
States have begun to take steps to implement the renewal/redetermination process already. For example, some states have started to reach out to beneficiaries to verify contact information. Some states have already begun to notify skilled nursing facilities of the upcoming changes to renewal/redetermination of benefits and clarified whether the beneficiaries’ current renewal month will be maintained going forward and/or when to begin to expect the full renewal/redetermination process to be implemented. Please examine and follow the guidelines set by your state Medicaid agency carefully to secure the most recent information pertaining to the termination of continuous enrollment and the implementation of the full renewal/redetermination process.
Although there will certainly be bumps that arise through this transition, we hope that they are minimal. If you have any questions regarding the new legislation, CMS guidance, or your state’s renewal/redetermination process, please reach out to us! We would be happy to help and offer our services for any issues that arise.
For further information on the CMS Guidance, please click the link below: https://www.medicaid.gov/federal-policy-guidance/downloads/cib010523.pdf
