AARP

MARCH 2023

PUBLIC POLICY INSTITUTE

Fact Sheet

Resumption of Medicaid Eligibility
Reassessments: Over 1 Million
Enrollees Ages 50 to 64 Could Lose

Their Benefits

Tobey Oliver
AARP Public Policy Institute

Before the COVID-19 pandemic, state Medicaid
programs typically reassessed enrollees'
eligibility at least once a year and would
disenroll them if they no longer qualified. The
pandemic put that practice on hold, however,
with a federal law passed in March 2020 that
required state Medicaid programs to keep
people enrolled throughout the public health
emergency. States received enhanced federal
funding for implementing the requirement.!

This policy-often referred to as continuous
enrollment-has led to a record-high Medicaid
enrollment of more than 84 million people

as of November 2022." Rates of uninsured
Americans have also dropped to record levels,
hitting a low of 8 percent in early 2022.3
Overall, continuous enrollment helped ensure
that tens of millions of people did not have to
worry about losing health coverage during a
time of health and economic uncertainty.

However, major changes are coming soon. A
spending bill that passed at the end of 2022 is
ending the continuous coverage protection,
and state Medicaid programs will once again
be able to disenroll people who are no longer
eligible starting on April 1, 2023.4 Previous
analyses suggest that 5 to 17.5 percent of
Medicaid enrollees could lose coverage during
this "unwinding" process.*

The AARP Public Policy Institute (PPI)
contracted with NORC at the University of

Chicago to further examine the implications
of the unwinding process for older Americans.
NORC analyzed Medicaid enrollment trends
for the 50-to-64 population before and during
the public health emergency and used these
data to model the impact of resuming Medicaid
eligibility reassessments, or redeterminations,
in this population. This paper discusses these
findings as well as their context within the
larger health care system. We also provide an
overview of federal and state actions taken in
advance of the April 1 changeover date and
discuss policy options that could help ease the
transition.

Impact on the 50-to-64 population

NORC's model predicts that the unwinding
process could result in 1 million people ages 50
to 64 being dropped from Medicaid over the
next year, from approximately 12.2 million as
of March 31, 2023, to an estimated 11.2 million
on April 1, 2024. This finding is due to a few
factors. Some individuals will be disenrolled
because they no longer qualify ¢.g., if their
income has increased), whereas others who
might otherwise still qualify will be disenrolled
due to administrative reasons-not receiving
necessary information, not understanding
material explaining steps they need to take
and therefore failing to take those steps, and
otherwise falling through the cracks.
MARCH 2023

Notably, NORC's model is based on
disenrollment trends prior to the public health
emergency. Because this historical data is not
reflective of the unique challenges created

by the public health emergency or sudden
resumption of eligibility reassessments, our
findings could in fact underestimate enrollment
changes. Examples of factors associated with
this uncharted territory include the following:

e Record-high Medicaid enrollment requires
a record-high number of redeterminations.®
States will have a limited time until
June 1, 2024 to complete all eligibility
redeterminations and disenrollments,
and state Medicaid officials report that
agencies are understaffed and have lost
institutional knowledge on conducting the
redetermination process.'

e Newer Medicaid enrollees are likely not as
familiar with the redetermination process
and how to complete it because many have
not gone through it previously.

e Enrollees may have moved and not updated
their address with their state Medicaid
agency and therefore may not receive their
redetermination notice. A Kaiser Family
Foundation analysis found that about 10
percent of Medicaid enrollees moved in
2020 alone.®

Despite the anticipated drop in enrollment
due to the unwinding process, NORC's model
estimates that the overall number of Medicaid
enrollees ages 50 to 64 will be 24 percent
larger in June 2024 than it was just before the
start of the pandemic (i.e., February 2020).
The number of people ages 50 to 64 who are
enrolled in Medicaid is expected to increase by
just over 1 million between February 2020 and
June 2024. Predictions for growth rates and
disenrollment rates vary significantly by state,
as detailed in the appendix.

Other coverage options, and connecting
consumers to them

In considering the end of continuous coverage
protections for Medicaid beneficiaries, it is

worthwhile to consider other health care
coverage options that individuals may be

able to access. Some people who no longer
qualify for Medicaid may have access to
health insurance coverage through their job
or employer. Also, people who lose Medicaid
eligibility due to higher income may be eligible
for financial assistance to defray the cost of a
private health insurance plan on the Health
Insurance Marketplace (Marketplace), created
by the Affordable Care Act.

An analysis by the Office of the Assistant
Secretary for Planning and Evaluation found
that almost one-third of individuals who lose
Medicaid coverage will qualify for Marketplace
premium assistance. Most of these individuals
(60 percent) may be eligible to have their
premiums fully covered.° However, research
has shown that among those individuals who
lose Medicaid coverage but are eligible to move
to subsidized Marketplace plans, few actually
enroll. A recent study by the Medicaid and
Children's Health Insurance Program (CHIP)
Payment and Access Commission (MACPAC)
found that only about 3 percent of people

who disenrolled from Medicaid enrolled in a
Marketplace plan within a year.!°

The federal government has put in place
several policies to help ease the transition from
Medicaid to Marketplace coverage, including
financial assistance, enrollment windows,

and connections between the Medicaid and
Marketplace eligibility processes. Federal
financial assistance in the form of premium tax
credits and cost-sharing reduction subsidies
are available to help people afford Marketplace
coverage. The availability of premium tax
credits, which the federal government has
significantly expanded through 2025, make
these plans more affordable to individuals
transitioning from Medicaid." Recent PPI
analyses estimate that these tax credit
expansions are critical to making health
coverage affordable and can save older adults
up to $4,700 in premiums and ensure that 1
million fewer older adults ages 50 to 64 are
uninsured."
MARCH 2023

In addition to providing this financial assistance,
to help people enroll in Marketplace coverage,
the federal government created a temporary
"unwinding" special enrollment period (SEP)
for people losing Medicaid or CHIP coverage
between March 31, 2023 and July 31, 2024."
People may also be eligible for other SEPs,"* and
people in most states with income levels under
150 percent of the federal poverty level and who
are also eligible for premium tax credits may be
eligible to enroll year-round.

Meanwhile, in anticipation of the unwinding,
state Medicaid officials have been working
closely with their Marketplace counterparts,
and both states and the federal government
have been developing communication strategies
to help ensure that people who lose Medicaid
are aware of Marketplace coverage options

and the availability of financial assistance. Ifa
state determines an individual's income to be
too high for Medicaid, it sends the applicant's
information to the Marketplace, helping connect
the two programs for the user. The Marketplace
eligibility system then sends a letter to the
person with information and instructions on
enrolling in a Marketplace plan.

Other federal and state efforts to mitigate
impact of unwinding process

Federal- and state-level agencies have been
actively working to prepare for the unwinding
in other areas as well. The Centers for Medicare
and Medicaid Services (CMS) has been
encouraging enrollees to update their contact
information with Medicaid agencies and to

be on the lookout for communications about
redeterminations. Federal and state officials
have also been working to improve coordination
between Medicaid and Marketplace enrollment
processes and make improvements to the
redetermination process to cut down on
disenrollments due to administrative reasons.

An enrollee's redetermination experience will
in part depend on their state. For example,
many states use available data to reduce

the amount of information enrollees need

to submit, and some states have focused

on improving data use and implementing
other system upgrades in the past few years.
However, the extent of data use and burden
on enrollees vary widely.'* States have also
employed varying approaches to education
and outreach and making information public."
(For specific examples of steps some states
are taking, see box "Notes From a MACPAC
Meeting: What States Are Doing on the
Ground.") Amid these varying efforts and
even despite the more proactive ones, many
people may remain unaware of the upcoming
changes. As of December 2022, more than

64 percent of adults who are enrolled in
Medicaid, or who have a family member who
is enrolled, were unaware of the upcoming
redetermination process.

Additional efforts needed

People who lose health insurance coverage
completely, even for short periods (sometimes
referred to as "churn"), are likely to experience
both financial and medical adverse impacts.
Loss of health care coverage leads people to
skip needed care and incur high costs to pay
for the care they do get.!® These stakes are also
higher for those ages 50 to 64 than for younger
groups:

e Twenty percent of 50- to 64-year-olds report
being in fair to poor health, compared with
11 percent of those ages 18 to 49. For those
who make less than 25,000 a year, this
number rises to 48 percent."°

e People ages 54 to 64 also report higher
rates of multiple common chronic health
conditions compared with younger
cohorts."!

Given the implications for millions of people,
as well as the increased reliance on Medicaid
among the 50-to-64 population, policymakers
should ensure that the unwinding/Medicaid
redetermination process goes as smoothly

as possible. Priorities should include the
following:

Ensuring sufficient state staffing. For a
redetermination effort to be successful,
states will need to ensure adequate staff in
MARCH 2023

 

Process

to other safety net services
provide

Engaging enrollees

enrollees

 

Notes From a MACPAC Meeting: What States Are Doing on the Ground

During a January 2022 public meeting of the Medicaid and CHIP Payment and Access Commission, several state
representatives discussed planning and process updates that they hope will help the redetermination process
go more efficiently and effectively." Highlights of such updates taking place included improvements to the
reassessment process and ways to engage enrollees more effectively:

e« Improved performance management and monitoring tools, including new dashboards
e Additional external support in coordinating enrollment between Medicaid and Marketplace plans and referrals

e Better use of data to streamline the process and minimize the amount of information that enrollees must

e Media campaigns to alert enrollees to the upcoming process

e Updating and improving enrollee communication materials and sharing sample language and clear
messaging strategies with community partners for consistent messaging to enrollees

e Creation of a return-mail center to standardize processes for undeliverable mail and take further steps to reach

 

 

several pivotal roles, including eligibility

case workers, call center staff, eligibility
systems support, and determination appeals
staff. This is an area of risk for states because
many current staff members have expressed
concern about adequate staffing. CMS has
gathered some best practices for states to
address these challenges, such as cross-
training state and county staff from other
agencies to help fill roles on a temporary basis
and creating specialized units to handle more
complex tasks."

Opportunities for enrollee feedback. So that
officials can address systemic issues as quickly
as possible, states should ensure they have
robust channels in place to gather reports of
enrollee concerns and problems experienced
in the redetermination process. Addressing
issues quickly will help ensure that enrollees

stay covered or transition smoothly to other
available coverage options.

Education and outreach efforts. CMS and
states should stay engaged with communities
to provide resources, such as those that help
explain the redetermination process or direct
people to local legal or advocacy entities that
can help them navigate the process.

Improved monitoring. States must submit
reports to CMS on the redetermination and
disenrollment processes, and CMS must make
the reports publicly available." CMS has not yet
provided information on how or where it will
publish these reports but will likely provide
updates on its website dedicated to guidance
and information on this process.** These
reports can provide important information for
policymakers and reveal insights that warrant
further investigation.
MARCH 2023

 

 

Appendix
Tice ati alate liy <3 Pace) rier lit <
50- to 64-year 50- to 64-year 50- to 64-year UEC aa li elu aa a is
oldenrollment old enrollment oldenrollment pandemic (February (February 2020) to
2/1/20 4/1/23 rR UPL 2020) to 4/1/23 4/1/24
State [observed] [projected] yay (raced [projected] [projected]

AK 28,233 34,936 32,492 23.7% 15.1%
AL 89,940 106,915 106,440 18.9% 18.3%
AR 113,650 148,644 134,946 30.8% 18.7%
AZ 221,059 317,039 286,770 43.4% 29.7%
CA 1,600,331 2,068,897 1,783,519 29.3% 11.4%
co 167,181 253,356 222,479 51.5% 33.1%
CT 127,597 159,324 150,234 24.9% 17.7%
DC 40,495 48,133 46,680 18.9% 15.3%
DE 33,643 45,031 39,302 33.9% 16.8%
FL 289,744 411,185 414,120 41.9% 42.9%
GA 145,638 178,673 175,908 22.7% 20.8%
HI 45,667 70,529 60,565 54.4% 32.6%
IA 86,552 110,578 105,155 27.8% 21.5%
ID 35,618 56,261 49,940 58.0% 40.2%
IL 377,313 575,520 525,682 52.5% 39.3%
IN 200,617 309,433 298,495 54.2% 48.8%
KS 34,603 40,169 40,246 16.1% 16.3%
KY 195,730 251,609 224,542 28.5% 14.7%
LA 198,285 267,793 247,840 35.1% 25.0%
MA 255,890 351,230 346,109 37.3% 35.3%
MD 170,787 230,496 205,108 35.0% 20.1%
ME 42,238 66,555 68,121 57.6% 61.3%
Ml 335,405 449,437 376,027 34.0% 12.1%
MN 127,040 174,225 164,100 37.1% 29.2%
MO 99,412 172,342 161,962 73.4% 62.9%
MS 74,650 84,886 86,248 13.7% 15.5%
MT 35,515 47,151 48,406 32.8% 36.3%
NC 181,312 248,121 240,327 36.8% 32.5%
ND 10,679 14,876 13,265 39.3% 24.2%
NE 18,130 33,813 30,744 86.5% 69.6%
NH 23,715 36,710 32,216 54.8% 35.8%
NJ 239,905 322,211 301,808 34.3% 25.8%
NM 95,788 122,210 113,288 27.6% 18.3%
NV 84,400 126,588 123,176 50.0% 45.9%
 

MARCH 2023

 

 

 

Enrollment change Enrollment change
50- to 64-year 50- to 64-year 50- to 64-year from start of from start of pandemic
old enrollment | old enrollment old enrollment | pandemic (February (February 2020) to
2/1/20 4/1/23 4/1/24 2020) to 4/1/23 rR UPL
[observed] [projected] [projected] [projected] [projected]

NY 942,988 1,260,072 1,180,737 33.6% 25.2%
OH 368,107 480,415 445,755 30.5% 21.1%
OK 69,823 104,841 95,114 50.2% 36.2%
OR 157,096 233,041 189,287 48.3% 20.5%
PA 440,763 583,754 506,244 32.4% 14.9%
RI 50,534 68,932 67,081 36.4% 32.7%
SC 99,960 124,788 120,923 24.8% 21.0%
SD 8,313 10,243 10,085 23.2% 21.3%
TN 148,804 173,753 167,076 16.8% 12.3%
TX 254,215 312,116 302,061 2.8% 18.8%
UT 28,817 48,854 45,261 69.5% 57.1%
VA 191,858 291,198 300,732 51.8% 56.7%
VT 23,174 32,178 29,805 38.9% 28.6%
WA 225,712 306,796 276,211 35.9% 22.4%
WI 131,680 186,196 167,933 41.4% 27.5%
WV 86,331 107,038 94,269 24.0% 9.2%
WY 4,656 6,466 6,619 38.9% 42.2%

Endnotes

1
2

Families First Coronavirus Response Act, Pub. Law No, 116-127, 2020, https://www.govinfo.gov/app/details/PLAW-116publ127,

"November 2022 Medicaid & CHIP Enrollment Data Highlights," Centers for Medicare & Medicaid Services (CMS), accessed February 6,
2023, https://www.medicaid.gov/medicaid/program-information/medicaid-and-chip-enrollment-data/report-highlights/index.html.

Aiden Lee, Joel Ruhter, Christie Peters, Nancy De Lew, and Benjamin D. Sommers, "National Uninsured Rate Reaches All-Time Low
in Early 2022," Office of the Assistant Secretary for Planning and Evaluation (ASPE), Data Point, August 2022, https://aspe.hhs.gov/
reports/2022-uninsurance-at-all-time-low.

Consolidated Appropriations Act, 2023, SEC. 5131, "Transitioning From Medicaid FMAP Increase Requirements," (tt)(1) https://
www.congress.gov/117/bills/hr2617/BILLS-117hr2617enr.pdf.

Jennifer Tolbert and Meghana Ammula, "10 Things to Know About the Unwinding of the Medicaid Continuous Enrollment
Provision," Kaiser Family Foundation (KFF), January 11, 2023, https://www.kff.org/medicaid/issue-brief/10-things-to-know-
about-the-unwinding-of-the-medicaid-continuous-enrollment-provision/; Matthew Buettgens and Andrew Green, "The Impact of
the COVID-19 Public Health Emergency Expiration on All Types of Health Coverage," Urban Institute, Research Report, December
2022, https://www.urban.org/sites/default/files/2022-12/The%20I|mpact%200f%20the%20COVID-19%20Public%20Health%20
Emergency%20Expiration%200n%20All%20Types%200f%20Health%20Coverage_0.pdf; "Unwinding the Medicaid Continuous
Enrollment Provision: Projected Enrollment Effects and Policy Approaches," ASPE, Office of Health Policy, /ssue Brief, August 19,
2022, https://aspe.hhs.gov/reports/unwinding-medicaid-continuous-enrollment-provision.

"Transitions Between Medicaid, CHIP, and Exchange Coverage," Medicaid and CHIP Payment and Access Commission (MACPAC),
Issue Brief, July 2022, https://www.macpac.gov/wp-content/uploads/2022/07/Coverage-transitions-issue-brief.pdf.

"Public Meeting," MACPAC, January 20, 2022, pp. 126-29, accessed February 16, 2023, https://www.macpac.gov/wp-content/
uploads/2021/04/MACPAC-January-2022-Meeting-Transcript.pdf.
MARCH 2023

8 Bradley Corallo and Jennifer Tolbert, "How Many Medicaid Enrollees Moved in 2020 and What Are the Implications for Unwinding
the Public Health Emergency?" KFF, March 17, 2022, https://www.kff.org/medicaid/issue-brief/how-many-medicaid-enrollees-
moved-in-2020-and-what-are-the-implications-for-unwinding-the-public-health-emergency/.

9 ASPE, "Unwinding the Medicaid Continuous Enrollment."
10 MACPAC, "Transitions Between Medicaid."

11 The American Rescue Plan Act of 2021 and the Inflation Reduction Act of 2022 together extend expanded tax credits through
2025. See Chiquita Brooks-LaSure and Dr. Ellen Montz, "Inflation Reduction Act Tax Credits Improve Coverage Affordability for
Middle-Income Americans," CMS, Blog, August 2022, https://www.cms.gov/blog/inflation-reduction-act-tax-credits-improve-
coverage-affordability-middle-income-americans, and Cynthia Cox, Krutika Amin, and Jared Ortaliza, "Five Things to Know about
the Renewal of Extra Affordable Care Act Subsidies in the Inflation Reduction Act," August 2022, KFF Policy Watch, https://www.
kff.org/policy-watch/five-things-to-know-about-renewal-of-extra-affordable-care-act-subsidies-in-inflation-reduction-act/.

12 Jane E. Sung and Olivia Dean, "Congressional Action Required to Keep Health Coverage Affordable for Many 50- to 64-Year
Olds," AARP Public Policy Institute (PPI), AARP Blogs, October 2021, https://blog.aarp.org/thinking-policy/congressional-action-
required-to-keep-health-coverage-affordable-for-many-50-to-64-year-olds; see also Jane Sung, Olivia Dean, Robert C. Saunders,
Julia Sheriff, and Aig Unuigbe, "Affordability Challenges for Older Adults in the Nongroup Market," AARP PPI, insight on the Issues,
March 2021, https://www.aarp.org/content/dam/aarp/ppi/2021/03/affordability-challenges-older-adults-nongroup-market.
doi.10.26419-2F ppi.00099.008. pdf.

13 "Temporary Special Enrollment Period (SEP) for Consumers Losing Medicaid or the Children's Health Insurance Program (CHIP)
Coverage Due to Unwinding of the Medicaid Continuous Enrollment Condition-Frequently Asked Questions (FAQ)," CMS, Center
for Consumer Information and insurance Oversight, January 27, 2023, https://www.cms.gov/technical-assistance-resources/temp-
sep-unwinding-faq. pdf.

14 "Special Enrollment Opportunities," HealthCare.gov, accessed March 13, 2023, https://www.healthcare.gov/coverage-outside-
open-enrollment/special-enrollment-period/.

15 "An SEP if Your Income Doesn't Exceed 150% of the Federal Poverty Level," Healthinsurance.org, accessed March 13, 2023,
https://www.healthinsurance.org/special-enrollment-guide/an-sep-if-your-income-doesnt-exceed-150-of-the-federal-poverty-
level/.

16 MaryBeth Musumeci, Molly O'Malley Watts, Meghana Ammula, and Alice Burns, "Medicaid Public Health Emergency Unwinding
Policies Affecting Seniors & People with Disabilities: Findings from a 50-State Survey," KFF, Issue Brief, July 2022, https://www.kff.
org/report-section/medicaid-public-health-emergency-unwinding-policies-affecting-seniors-people-with-disabilities-findings-
from-a-50-state-survey-issue-brief/.

17 "50-State Unwinding Tracker," Georgetown University Health Policy Institute, Center for Children and Families, September 2022,
accessed February 17, 2023, https://ccf.georgetown.edu/2022/09/06/state-unwinding-tracker/.

18 Jennifer M. Haley, Genevieve M. Kenney, Stephen Zuckerman, Michael Karpman, Dulce Gonzalez, "Update: Awareness of the
Resumption of Medicaid Renewal Processes Remained Low in December 2022," Urban Institute, Fact Sheet, February 16, 2023,
https://www.urban.org/research/publication/update-awareness-resumption-medicaid-renewal-processes-remained-low-
december.

19 Allyson G. Hall, Jeffrey S. Harman, and Jianyi Zhang, "Lapses in Medicaid Coverage: Impact on Cost and Utilization Among
Individuals With Diabetes Enrolled in Medicaid," Medical Care 46, no. 12 (December 2008): 1219-25, https://journals.lww.com/
lww-medicalcare/Abstract/2008/12000/Lapses_in_Medicaid_Coverage__Impact_on_Cost_and.5.aspx; Veri Seo, Travis P.
Baggett, Anne N. Thorndike, Peter Hull, John Hsu, Joseph P. Newhouse, and Vicki Fung, "Access to Care Among Medicaid and
Uninsured Patients in Community Health Centers After the Affordable Care Act," BMC Health Services Research 19, Article 291,
2019, https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-019-4124-z; Xu Ji, Adam S. Wilk, Benjamin G.

Druss, and Janet R Cummings, "Effect of Medicaid Disenrollment on Health Care Utilization Among Adults with Mental Health
Disorders," Medical Care 57, no. 8 (August 2019): 574-83, https://pubmed.ncbi.nlm.nih.gov/31295187/; K. Robin Yabroff, Katherine
Reeder-Hayes, Jingxuan Zhao, Michael T Halpern, Ana Maria Lopez, Leon Bernal-Mizrachi, Anderson B Collier, Joan

Neuner, Jonathan Phillips, William Blackstock, and Manali Patel, "Health Insurance Coverage Disruptions and Cancer Care and
Outcomes: Systematic Review of Published Research," Journal of the National Cancer institute 112, no. 7 (July 2020): 671-87,
https://pubmed.ncbi.nlm.nih.gov/32337585/; Joel S. Weissman, Robert Stern, Stephen Fielding, and Arnold M. Epstein, "Delayed
Access to Health Care: Risk Factors, Reasons, and Consequences," Annals of Internal Medicine 114, no. 4 (February 1991): 325-31,
https://pubmed.ncbi.nlm.nih.gov/1899012/.

20 PPI analysis of 2017-21 Behavioral Risk Factor Surveillance System data.
MARCH 2023

21 Prevalence of chronic health conditions for ages 50 to 64 vs. under 50 in 2021: arthritis 35 percent vs. 10 percent; cancer 13
percent vs. 3 percent; chronic kidney disease 4 percent vs. 1 percent; COPD 9 percent vs. 3 percent; prediabetes 17 percent vs.
7 percent; diabetes 16 percent vs. 4 percent; heart disease 5 percent vs. 1 percent; and high blood pressure 43 percent vs. 16
percent. From PPI analysis of 2017-21 Behavioral Risk Factor Surveillance System data.

22 "Medicaid and CHIP Unwinding Planning Efforts Summary of Best & Promising State Practices from CMS/State Discussions
April 2022," CMS, April 2022, slide 11, "Theme 3: Workforce Capacity," accessed February 17, 2023, https://www.medicaid.
gov/resources-for-states/downloads/state-unwinding-best-practices.pdf; "Strategies States and the U.S. Territories Can
Adopt to Maintain Coverage of Eligible Individuals as They Return to Normal Operations," CMS and Medicaid and CHIP Learning
Collaboration, November 2021, pp. 13-14; "Address Potential Strains on Eligibility and Enrollment Workforce," https://www.
medicaid.gov/state-resource-center/downloads/strategies-for-covrg-of-indiv.pdf.

23 "Consolidated Appropriations Act, 2023," SEC. 5131. Transitioning from Medicaid FMAP Increase Requirements, (tt)(1), accessed
March 13, 2023, https://www.congress.gov/117/bills/hr2617/BILLS-117hr2617enr.pdf.

24 "Unwinding and Returning to Regular Operations after COVID-19," CMS, accessed March 13, 2023, https://www.medicaid.gov/
resources-for-states/coronavirus-disease-2019-covid-19/unwinding-and-returning-regular-operations-after-covid-19/index.html.

25 "Public Meeting," January 20, 2022; examples of work in other states can be found in Becky Lopez, "Communicating the PHE
Unwinding: How States Are Conducting Outreach and Planning," State Health and Value Strategies, November 2022, https://www.
shvs.org/communicating-the- phe-unwinding-how-states-are-conducting-outreach-and-planning/.

Fact Sheet 1605002, March 2023

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