Rural Health Information Hub Latest News

Transition Forward: Updated Medicaid Unwinding Resources Now Available

On May 11, 2023, the federal Public Health Emergency (PHE) for COVID-19 expired. Some Medicaid services, such as telehealth flexibilities, will not be affected and have been extended through December 31, 2024, as indicated in The Consolidated Appropriations Act of 2023.

There are certain Medicare and Medicaid waivers, broad flexibilities for health care providers, and coverage for COVID-19 testing that will be affected.

To better assist with the impact PHE unwinding will have on different areas of people’s health, the Centers for Medicare & Medicaid Services Office of Minority Health (CMS OMH) updated its Coverage to Care (C2C) resources to help the consumers you serve understand their health coverage.

Updated C2C Resources Available

Ahead of PHE Unwinding, these resources will help consumers prepare to transition forward and continue to feel confident in how they will receive coverage for COVID-19 testing and telehealth services.

The following resources are now available on the C2C website:

  • C2C COVID Overview Factsheet Explains basics of health coverage for protecting you and your family, Medicare updates, Medicaid renewal (new!), and more.
  • C2C Telehealth Patient Toolkit Serves as a guide to explain telehealth basics and help patients and their families properly navigate telehealth services.
  • C2C Telehealth Provider Toolkit Provides informational tips to assist providers with implementing telehealth services to their patients.

Spread the Word: Renewing Medicaid/CHIP Coverage

Additionally, to ensure Medicaid and CHIP beneficiaries are up to date on the Medicaid continuous enrollment condition that expired on March 31st, CMS has created many resources, including the Anticipated 2023 State Timelines for Initiating Unwinding-Related Renewals as of February 24, 2023 (PDF, 93 KB, 2 pp).

For the most updated information about Medicaid and CHIP renewal processes, we encourage all enrollment assisters and outreach workers to communicate with Medicaid and CHIP beneficiaries the following three important messages:

  • Update your contact information – Make sure the state Medicaid agency or CHIP program has your current mailing address, phone number, email address, or other contact information so they can contact you about your Medicaid or CHIP renewal
  • Check your mail – State Medicaid agencies or CHIP programs will mail you a letter about your Medicaid or CHIP coverage
  • Complete your renewal form (if you get one) – Fill out the form and return it to the state Medicaid agency or CHIP program right away to help avoid a gap in your Medicaid or CHIP coverage

Make sure to review the updated communications toolkit, Medicaid and CHIP Continuous Enrollment Unwinding (PDF, 3.2 MB, 21 pp) and the Medicaid Unwinding Toolkit Supporting Materials (ZIP, 47 MB) to help inform people with Medicaid or CHIP about steps they should take to renew their coverage or find other health care options. *People who no longer qualify for Medicaid or CHIP are advised to visit to find out if they are eligible to enroll in a Marketplace plan.

Preparing for Medicaid Unwinding is important for all. To learn more about the Unwinding and Medicaid and CHIP Renewals, visit CMS OMH at

You Can Read About the Guidance for States on Ending COVID-19 PHE Medicaid Flexibilities Here!

 This Center for Medicaid & CHIP Services (CMCS) Informational Bulletin (CIB) lists the end dates of certain COVID-19-related Medicaid and CHIP coverage and enhanced federal funding if the COVID-19 Public Health Emergency (PHE) ends on May 11, 2023, as expected. As part of their response to the COVID-19 PHE, states adopted many temporary flexibilities to support providers and individuals enrolled in Medicaid and CHIP, such as coverage of COVID-19 testing, treatment, and vaccinations.  The bulletin provides key dates to assist states with returning to routine Medicaid and CHIP operations.  About a quarter of rural adults under age 65 are covered by Medicaid.

Timeline of End Dates for Key Health-Related Flexibilities Provided Through COVID-19 Emergency Declarations, Legislation, and Administrative Actions

In response to the unprecedented nature of COVID-19, the federal government declared numerous types of emergencies, Congress enacted several pieces of legislation, and various executive actions were taken and waivers issued, which, collectively, established time-limited flexibilities and provisions designed to protect individuals and the health system during the pandemic. The effective end dates of many, though not all, of these flexibilities and provisions are tied to the public health emergency (PHE) declaration made pursuant to Section 319 of the Public Health Service Act, first declared in January of 2020.  Others are linked to the public health emergency declaration made under Section 564 of the Federal Food, Drug and Cosmetic (FD&C) Act; the declaration made under the Public Readiness and Emergency Preparedness (PREP) Act; and emergency and major disaster declarations made under the Stafford Act. In some cases, subsequent legislation has either delinked provisions from these declarations or otherwise changed their duration.

The Biden Administration recently announced that it will end the PHE on May 11, 2023 and FEMA has announced that the emergency incident period under the Stafford Act will also end on that date. Other related emergency declarations or provisions have already ended or are ending soon. The following table (Table 1) provides a timeline identifying key health-related flexibilities and provisions specified by these various measures, the specific measure that determines their end date, and their end date (an end date for the Section 564 declaration has not yet been announced).

In addition to the end of the flexibilities detailed in Table 1 below, there are also expectations that the federal supply of COVID-19 vaccines could be depleted or need to be replaced by an updated booster dose sometime this year and, similarly, the federal supply of COVID-19 treatments will also be depleted. At a result, COVID-19 vaccines and treatments are transitioning to the commercial market. Importantly, this change is not tied to the end of the public health emergency.

Click here to see the list of deadlines in the referenced table.

COVID-19 Vaccines and Treatment Program for the Uninsured Have Been Announced

The Biden administration has announced the launch of a $1.1 billion public-private partnership called “Bridge Access Program” aimed at giving uninsured individuals access to COVID-19 vaccines and treatments by the U.S. Department of Health and Human Services (HHS). At the end of the Public Health Emergency, the financial obligation of paying for these vaccines and treatments shifts to the private sector. Most people should continue to pay nothing out-of-pocket for vaccines but out-of-pocket expenses for treatments such as Paxlovid may change. The program has two components which include ensuring safety net programs like Community Health Centers will receive vaccines purchased at a discounted rate from the CDC and HHS will contract with pharmacies that will allow them to continue to provide COVID-19 treatments like Paxlovid free of charge to the uninsured.

Frequently Asked Questions (FAQs) on CMS Waivers, Flexibilities, and the End of the COVID-19 Public Health Emergency

The Department of Health and Human Services is planning for the federal Public Health Emergency for COVID-19 (PHE), declared under Section 319 of the Public Health Service Act, to expire at the end of the day on May 11, 2023. Today, the Centers for Medicare & Medicaid Services (CMS) issued FAQs on CMS Waivers, Flexibilities, and the End of the COVID-19 PHE. The FAQs will help you prepare for the expiration of the COVID-19 PHE and are relevant for all CMS programs; including, Medicare, Medicaid, the Children’s Health Insurance Program (CHIP), and private insurance.

CMS resources for the expiration of the COVID-19 PHE:

President Biden Ends COVID National Emergency After Congress Acts

The U.S. national emergency to respond to the COVID-19 pandemic ended Monday as President Joe Biden signed a bipartisan congressional resolution to bring it to a close after three years — weeks before it was set to expire alongside a separate public health emergency.

The national emergency allowed the government to take sweeping steps to respond to the virus and support the country’s economic, health and welfare systems. Some of the emergency measures have already been successfully wound-down, while others are still being phased out. The public health emergency — it underpins tough immigration restrictions at the U.S.-Mexico border — is set to expire on May 11.

The White House issued a one-line statement Monday saying Biden had signed the measure behind closed doors, after having publicly opposed the resolution though not to the point of issuing a veto. More than 197 Democrats in the House voted against it when the GOP-controlled chamber passed it in February. Last month, as the measure passed the Senate by a 68-23 vote, Biden let lawmakers know he would sign it.

The administration said once it became clear that Congress was moving to speed up the end of the national emergency it worked to expedite agency preparations for a return to normal procedures. Among the changes: The Department of Housing and Urban Development’s COVID-19 mortgage forbearance program is set to end at the end of May, and the Department of Veterans Affairs is now returning to a requirement for in-home visits to determine eligibility for caregiver assistance.

Legislators last year did extend for another two years telehealth flexibilities that were introduced as COVID-19 hit, leading health care systems around the country to regularly deliver care by smartphone or computer.

More than 1.13 million people in the U.S. have died from COVID-19 over the last three years, according to the Centers for Disease Control and Prevention, including 1,773 people in the week ending April 5.

Then-President Donald Trump’s Health and Human Services Secretary Alex Azar first declared a public health emergency on Jan. 31, 2020, and Trump declared the COVID-19 pandemic a national emergency that March. The emergencies have been repeatedly extended by Biden since he took office in January 2021, and he broadened the use of emergency powers after entering the White House.

Brief Released on a National Initiative to Address COVID-19 Heath Disparities

The Southwest Rural Health Research Center released the results of a qualitative study on a CDC COVID grant, “National Initiative to Address COVID-19 Health Disparities Among Populations at High-Risk and Underserved, Including Racial and Ethnic Minority Populations and Rural Communities.”

The grant included a financial “carve-out” designed to provide support to rural areas (approximately 19%, or $427m allocated of the grant’s total funding) which required recipients “who serve rural communities” to “define these communities and describe how they will provide direct support (e.g., funding, programs, or services) to those communities.” State government recipients were also required to “engage their State Office of Rural Health or equivalent, in planning and implementing their activities.”

Key findings from the study:

  • “The CDC’s COVID-19 rural carve-out, which explicitly designates a portion of funds for rural areas, has widespread support among stakeholders, with most encouraging the use of carveouts for future grant programs as well.
  • The development of the carve -out at the CDC was a complex and multi-faceted process, in part because it was a new type of funding mechanism.
  • The carve-out has provided many leaders in State Offices of Rural Health a ‘seat at the table’ in state public health decision-making.
  • Funds are being used in interesting and creative ways, but it is too soon to evaluate the impact of funds on rural communities.
  • Despite program support, the rural carve-out has seen some challenges tied to rural administrative capacity, sustainability, and timing, as has been seen with other rural health initiatives during the pandemic.”

Read About Guiding Rural Health Clinics at the End of the Public Health Emergency Here

  The National Association of Rural Health Clinics first describes some of the COVID-related waivers and flexibilities that applied widely – such as those reducing barriers to telehealth – and then those that were specific to RHCs.  These include relaxed requirements that physicians provide medical direction to nurse practitioners and justification to provide home nursing services, among others.  These waivers will end with the public health emergency.