Preparing for the Biggest Coverage Event Since the Affordable Care Act

Perspectives From State Health Officials on the End of Medicaid's Continuous Coverage Requirement

A meeting of medical professionals.

The formal ending of the COVID-19 public health emergency means new challenges for state Medicaid and Marketplace officials as Medicaid’s continuous coverage requirement expires.

The Issue

States are identifying tactics to manage unprecedented coverage turnover as millions are at risk of becoming uninsured when the public health emergency ends. An analysis examines significant challenges and solutions identified by state health officials to mitigate coverage losses.

Key Findings

  • Unprecedented caseloads with limited budgets and time: Several states intend to triage populations for earlier or later renewals to mitigate heavy caseloads.

        o Officials in one state plan to target postpartum women enrolled in Medicaid for immediate renewal to avoid unnecessary coverage losses among new mothers and babies.     

  • Raising awareness: States must communicate early and often to help individuals navigate to a new plan. 

        o Several states are developing communication campaigns to inform Medicaid enrollees about retaining coverage or transitioning to a new plan. 

        o Many states plan to leverage Medicaid managed-care organizations, Marketplace plans, navigators, and providers to provide education and enrollment assistance. 


Researchers determine that states face many risks when it comes to the end of the public health emergency. Many are already implementing new strategies to ensure enrollees do not lose coverage. Researchers say the federal government can help mitigate coverage losses by ensuring state officials have clear and timely policy guidance, encouraging cross-agency collaboration, and providing real-time technical assistance.

About the Urban Institute

The nonprofit Urban Institute is dedicated to elevating the debate on social and economic policy. For nearly five decades, Urban scholars have conducted research and offered evidence-based solutions that improve lives and strengthen communities across a rapidly urbanizing world. Their objective research helps expand opportunities for all, reduce hardship among the most vulnerable, and strengthen the effectiveness of the public sector. Visit the Urban Institute’s Health Policy Center for more information specific to its staff and its recent research.