September 2021 Medicaid Changes

Public Health Emergency (PHE)  

So far, the PHE has been approved in 3-month increments, and the last renewal was on July 20th. It will be up for renewal again in mid-October. This is the sixth renewal since the pandemic, and it is expected that the PHE will continue through the remainder of the year. 

Planning for the resumption of the normal state of Medicaid 

On August 13th, CMS issued guidance on resuming back to normal Medicaid determinations. The updated guidance letter to state health officials outlines policy changes CMS is making to better support states as they address the large volume of pending eligibility and enrollment actions they will need to take after the PHE ends to minimize beneficiary burden.  

This letter includes extending the timeframe for completing pending eligibility and enrollment actions up to a year after the PHE and resuming timely processing of applications within four months of the PHE. 

Medicaid State of the Union 


HB 21-1232 was developed to implement a state-run health insurance option through the marketplace. The new plan is called the Colorado Option. There were several iterations of the law but the final version passed. Portions of the law will be implemented in 2022, but the bulk of the changes will go into effect in 2023.     


The state currently closed out the 2021 sessions with no base rate cuts to hospitals. Open enrollment for the Medicaid Managed Care plans begins October 1st.  

In addition, WellCare and Staywell will be merging with Sunshine State Health Plan on October 1st.  


Georgia’s limited expansion is delayed by CMS due to work requirements. The plan was to pause the implementation of this partial expansion, but CMS is pushing back and we might not see a final decision until 2022 or it may be rescinded.  

Louisiana and Mississippi  

CMS declared a Public Health Emergency for Louisiana and Mississippi announcing flexibilities for those affected by Hurricane Ida. This includes the already available COVID-19 waivers, a disaster toolkit to support Medicaid operations and ensure a continuity of coverage, dialysis care and assistance with medical supplies. There are additional flexibilities, but most are about easing access to care. 

Additionally, with COVID-19 surges putting strains on hospital capacities, the Louisiana Hospital Association is urging CMS to waive the prior authorization requirement, bringing guidelines in alignment with the Louisiana Department of Health’s temporary removal of the requirement.  


Missouri voters approved Medicaid expansion, but it was not funded through the legislative sessions. After legal battles, the Missouri Supreme Court ruled expansion as constitutional and ordered that the application process begin immediately. 

New Hampshire 

New Hampshire is planning for the redetermination of their Medicaid population, but cannot do so until the Public Health Emergency ends. State officials estimate once the PHE is over there could be around 30,000 people who no longer qualify for Medicaid, but have been kept on the program through the pandemic.  


Oklahoma expanded as of July 1st and nearly 170,000 Oklahomans have qualified since then.   

Also, the state has an 1115 waiver that was supposed to be effective July 1st, but it has not been approved by CMS. One of the biggest impacts of that approval is not allowing retro Medicaid for the expanded population. So far, it is unclear if the current CMS administration will support the request.  


The state now has a third special session starting on September 20th to complete any agenda items from the previous sessions, in addition to new topics. 

The Texas legislature extended Medicaid postpartum coverage from two to six months. The law also requires the Texas Health and Human Services Commission to ensure Medicaid managed care plans provide continuity of care for individuals in the Healthy Texas Women program to improve maternal health outcomes.   

In August, a federal judge issued a ruling that temporarily reinstated a ten-year extension of Texas’ Medicaid 1115 waiver.