End Of Continuous Medicaid Coverage Coming

After three years, the Texas Health and Human Services Commission (HHSC) is set to resume redeterminations for Medicaid clients’ eligibility in the coming months. The official end date of the continuous coverage requirement is March 31st. However, the process of renewing the entire Medicaid caseload will be a huge undertaking that will span many months.

As we approach this huge process, we wanted to share resources with you to help you understand what this means for your Medicaid patients, what the process will look like, and key messages you can share.

We will be closely monitoring this process, meeting regularly with HHSC, and coordinating with external partners. We will share updates with you via email and on the TPS website. If you have any questions about this process, need additional resources, or have requests for additional outreach materials, please reach out to Allison McHorse at Allison.McHorse@txpeds.org or (512) 370 -1512.


Background on Continuous Coverage:

Since the start of the pandemic, states have been prohibited from disenrolling anyone who had Medicaid coverage on March 18, 2020 or who has enrolled since until the expiration of the COVID-19 public health emergency (PHE) response. In exchange, state Medicaid programs have received an increase in federal matching funds.

For over two years, this provision was tied to extensions of the federal PHE declaration, so timeline for its expiration continued to change. However, there is now a confirmed date. The federal spending bill passed at the end of the year included a provision that will allow states to end the continuous coverage requirement after March 31, 2023.

The Texas Health and Human Services Commission is now working to finalize plans and timelines for redeterminations to comply with guidance from the Centers for Medicare and Medicaid.


Texas's Plan for Unwinding Continuous Coverage

Texas now will have 12 months to initiate renewals for the entire Medicaid caseload. All members must receive a full and fresh redetermination during this timeframe. This includes members who successfully reenrolled in the past year, who will most likely continue their current review schedule. 

Texas Medicaid has a three-phase plan to redetermine eligibility for more than 2.5 million Medicaid patients in just 8 months. Individuals HHSC has flagged as having benefited from continuous coverage are divided across three cohorts for which renewal notices will be sent: 

  1. Cohort 1: Individuals who are most likely to be ineligible or transitioned to the Children's Health Insurance Program (CHIP). For example, women who were pregnant who may transition to Healthy Texas Women and members who aged out of Medicaid.
  2. Cohort 2: Individuals likely to transition to a different Medicaid eligibility group.
  3. Cohort 3: Everyone remaining from the previous groups, including those most likely to remain eligible.

Again, those who have renewed successfully are most likely not included in these cohorts. If they attempted to renew but would have been found ineligible, their coverage was maintained, and they will have a fresh redetermination within those cohorts.

Texas sent out an initial notice the beginning of February to individuals in these cohorts to tell them that redeterminations will begin soon and to be on the lookout for packets. 


Expected Timeline 

  • February 2023 - Texas sent out initial notices too individuals who have benefited from continuous coverage to inform them that redeterminations would begin soon and to be on the lookout for packets. 
  • March 2023 - HHSC will begin checking electronic data sources for members in the first cohort. 
  • April 8, 2023 - Renewal packets and requests for information for members in the first cohort will be sent. 
    • Packets for the second cohort will go out in May and the third cohort will go out in April. 
  • June 1, 2023 - The earliest effective date for the first cohort to be disenrolled. 

Texas currently plans to initiate renewals for the second and third cohorts in successive months. 

Details of Renewals and Rederminations

  • Families have 30 days to respond to renewals. They also now have 30 days (up from 10) to respond to requests for additional information. 
  • Texas will initiate renewals for an entire household at once. This will put the whole family on the same renewal cycle moving forward.
  • Clients who are no longer eligible for the program they are currently on, will be automatically checked for eligibility for other programs (different Medicaid programs, CHIP, or Healthy Texas Women).
  • HHSC is required to use at least 2 forms of communication to contact families – mail & phone, or mail & text. MCOs will also be participating in outreach efforts. 


Verifying Patient's Medicaid Coverage

Practices should expect to reverify patient's Medicaid eligibility. This can be done through the Texas Medicaid & Healthcare Partnership's (TMHP) TexMed Connect Portal. 

You can also call 2-1-1. Press option 2 after the language prompt, and then option 2 again. Be prepared to provide your National Provider Identifier (NPI).  


Key Messages to Share with Patients

  1. Look for notices from HHSC in YELLOW envelopes that say "ACTION REQUIRED" in RED lettering. Notices will come in the mail and/or via portal if clients chose electronic notices.  Respond quickly when they receive it. 
  2. Urge patients to update their information with Texas Medicaid as soon as possible, especially if contact information has changed. They can do this by logging into their account on TexasBenefits.com or through the mobile app. 
  3. If patients don't have an account, they can create one on the website or mobile app. They can also call 2-1-1 and choose option 2 to update their information. 


Communications Resources

HHSC has put together a toolkit of resources to help communicate with patients and families about these upcoming changes. You can download these resources at the link above or below. 

You can also direct families to hhs.texas.gov/update for the most recent information on the end of continuous coverage from the agency. 

Our partners at Texans Care for Children and the Texas Association of Community Health Centers have put together this website with more information for Medicaid members: https://www.staycoveredtx.org/

Additional Resources


If you have any questions about this process, need additional resources, or have requests for additional outreach materials, please reach out to Allison McHorse at Allison.McHorse@txpeds.org or (512) 370 -1512.