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New Tools for Medicaid Fair Hearings, PHE Unwinding

Two new tools from the Centers for Medicare & Medicaid Services (CMS) prepare state Medicaid programs for a return to normal eligibility and enrollment operations when the COVID-19 public health emergency (PHE) ends. States will have up to 14 months after the PHE ends to return to normal operations.

The agency anticipates an increase in requests for fair hearings to determine an individual’s Medicaid eligibility or coverage. “Strategic Approaches to Support State Fair Hearings as States Resume Normal Eligibility and Enrollment Operations after the COVID-19 PHE” provides steps for states to:

  1. assess the fair hearing process and capacity;
  2. review strategies to mitigate anticipated fair hearing volume, including redeploying state resources, expanding informal resolution processes, and streamlining fair hearing operations; and
  3. consider requesting authority under section 1902(e)(14)(A) of the Social Security Act to implement a mitigation strategy.

CMS also released “Medicaid and CHIP Unwinding Planning Efforts; Summary of Best & Promising State Practices from CMS/State Discussions.” This summary outlines strategies for state programs to prepare for a return to normal operations in four areas:

  • renewals and redeterminations;
  • updating enrollee contact information;
  • workforce capacity; and
  • outreach, partnerships, and communication

Additional resources are available at medicaid.gov/unwinding.

Contact Senior Director of Policy Erin O’Malley at eomalley@essentialhospitals.org or 202.585.0127 with questions.

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About the Author

Julie Kozminski is a senior policy analyst at America's Essential Hospitals.

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