NC Medicaid Managed Care
County Playbook
Fact Sheet
Continuous Coverage Unwinding
The Consolidated Appropriations Act (also known as the Omnibus Bill) was signed into
law on December 29, 2022. It decouples the continuous coverage requirement from the
federal COVID-19 Public Health Emergency (PHE).
Under the Omnibus Bill, state Medicaid programs are required to end continuous Medicaid coverage
by April 1, 2023. In addition, the bill:
•
Permanently extends postpartum coverage.
•
Reduces the COVID-19 enhanced Federal Medical Assistance Percentage (FMAP) of 6.2% on a
quarterly basis in 2023. Enhanced FMAP will end on December 31, 2023.
Due to the 90-day renewal process in North Carolina, the first termination will be effective
July 1,
2023.
States have 12 months to initiate renewals and 14 months to complete renewals. If a
beneficiary reports a change in circumstance on or after April 1, 2023, they could be terminated with
an effective date as early as May 1, 2023.
NC Medicaid will use a renewal-age based approach
(not population-based)
for recertifications.
Caseworkers should work recertifications as they are due, according to policy.
State of North Carolina • Department of Health and Human Services • Division of Health Benefits (NC Medicaid)
medicaid.ncdhhs.gov • NCDHHS is an equal opportunity employer and provider. MONTH/YEAR
NEW REQUIREMENTS
The Omnibus Bill established new requirements, such as reporting the numbers of recertifications
initiated and completed each month during the unwinding period. There are also new requirements
related to contacting beneficiaries, for which NC Medicaid will automate as much as possible to
reduce the burden on the local DSS.
To keep the enhanced Federal Medical Assiatance Percentage (FMAP), Medicaid is required to
report recertifications to be completed during the unwinding period to CMS. The report completed by
Medicaid will be available to the public on this webpage medicaid.ncdhhs.gov/federally-required-
reports
Medicaid is required to make a “good faith effort” to reach beneficiaries using at least two different
modalities before terminating Medicaid benefits for procedural reasons. This is a two-part
requirement:
1)
Medicaid must make an effort to obtain up-to-date contact information (mailing address, phone
number, email, etc.) from all beneficiaries before the start of recertification.
To meet this requirement, Medicaid will conduct an outreach campaign to beneficiaries via text
messages, emails, robo calls and other means requesting they contact their local DSS or login to
their ePASS account to update their information.
These efforts will be conducted
from March 2023 through February 2024.
DSS offices should
expect higher than normal volumes of people calling to update their information in
response to this outreach, and be ready to update contact information in NC FAST.
2) Requests for additional information will be sent via the NCF-20020 Medical Assistance
Renewal Form and/or DHB-5097 Request for Information via mail. If these get returned as
undeliverable to the agency, CMS requires attempts be made to reach the beneficiary by two
additional modalities prior to terminating the case.
Modalities include:
a. Re-sending the mail to a forwarding address.
b. Phone call
c. Text message
d. Email
Weekly automated texts and emails will be sent from
April 2023 to March 2024
to beneficiaries
whose recertification is in an “In Progress” status and were sent a renewal form (NCF-20020) or a
Request for Information (DHB-5097) in NC FAST. Weekly robo call reminders will be made to these
beneficiaries.
If the DSS receives the NCF-20020 or DHB-5097 sent during a recertification as returned mail and
there is a forwarding address on the envelope, it must be mailed to the forwarding address. If a
forwarding address is found by other means, such as contact with the beneficiary or after a review of
available sources to the agency, it must be mailed to the new address.
The automated outreach planned by Medicaid for the unwinding period meets the two-part
requirement, therefore no additional outreach is required by the DSS other than mailing the
notices to the forwarding address.
State of North Carolina • Department of Health and Human Services • Division of Health Benefits (NC Medicaid)
medicaid.ncdhhs.gov • NCDHHS is an equal opportunity employer and provider. MONTH/YEAR
RECERTIFICATION REFRESHER TRAINING
Medicaid is hosting four live webinars on completing recertifications. Training includes basic
instructions for completing Medicaid recertifications and important guidelines and details on new
flexibilites authorized by CMS to help improve ex parte rates.
Session dates are as follows:
•
Wednesday, March 8 at 1– 4 p.m.
•
Tuesday, March 14 at 1– 4 p.m.
•
Thursday, March 16 at 9 a.m. – noon
•
Tuesday, March 21 at 1 p.m. – 4 p.m.
A recorded session and the slide deck will be posted to the Learning Gateway along with Q &
A. County supervisors can submit questions to an established training email address. More
information can be found here download (ncdhhs.gov)
ADDITIONAL LINKS
For more information about Continous Coverage Unwinding, visit the following resources.
Key Dates Related to the Medicaid Continuous Enrollment Condition Provisions in the Consolidated
Appropriations Act, 2023
Unwinding and Returning to Regular Operations after COVID-19 | Medicaid
Medicaid Continuous Enrollment Condition Changes
