As advocates are laser-focused on ensuring Congress passes important health care items in Build Back Better and preparing for upcoming legislative sessions, not to mention navigating the ongoing COVID-19 pandemic, it has been difficult to also dedicate time to planning for the end of the public health emergency (PHE) and what it means for people in their states.  Previous Community Catalyst blogs have chronicled guidance released by the Centers for Medicare and Medicaid Services as to how states should unwind PHE protections, but this doesn’t mean every state will be following the guidance as intended. For states that choose to rush their timeline to conduct redeterminations or fail to properly conduct outreach to Medicaid enrollees, there is potential for significant numbers of disenrollments. This presents very troubling equity concerns and risks driving up state uninsured rates.

Even before the COVID-19 pandemic, there existed disparities in who relies on Medicaid for health coverage. In fact, more than half of Medicaid enrollees identify as Black, Hispanic, Asian American, or another non-white race or ethnicity. The COVID-19 pandemic only exacerbated these enrollment trends as those most affected by financial hardship during the pandemic (e.g., job loss) were essential workers and Black and brown people, the same populations that suffered the highest rates of COVID-19 illness. This means that those most likely to be affected by disruptions in coverage would disproportionately be people of color.    

In a series of upcoming blogs, we will uplift useful resources for advocates regarding the unwinding of the PHE protections as well as highlight what we are hearing from various states in an effort to anticipate equity concerns and curtail projected massive disenrollments 

When should advocates begin communicating about the end of the PHE to the public and what should we be saying?  

The answer to the first question is now. There is a sense of urgency in communicating with current Medicaid enrollees who are at risk of being disenrolled, specifically in updating mailing addresses and other contact information. 

Housing instability has only worsened during the pandemic, as people have been more likely to experience financial hardship and change addresses during this period. Due to a greater reliance on the continuous coverage provision during the PHE, which has allowed Medicaid enrollees to maintain their coverage despite changes in income or address, people have not prioritized reporting address changes to their designated Medicaid offices. These folks face a greater chance of being disenrolled due to returned mail and the inability to receive redetermination notices and other Medicaid agency communications. It is imperative that Medicaid enrollees update their addresses with their Medicaid offices and advocates can begin communicating this now. 

Advocates can utilize these messages and graphics to share with community partners and key messengers. Notably, messages and graphics must be in multiple languages to ensure that as many people as possible will understand the important information being disseminated. Furthermore, advocates should view overcommunicating as the standard to helping people maintain their coverage. Repeated strongly worded communication contacts will impress upon people the gravity of the situation and take the necessary steps to stay enrolled in Medicaid.  

Where can advocates get started?  

  1. Coalition building. Through building coalitions, organizations can share intel, tackle multiple issues simultaneously (e.g., outreach to public, interface with Medicaid agencies), and determine who should be on your side (e.g., navigators, community leaders).  

  1. Utilize Georgetown’s Center for Children & Families (CCF) messaging guide and strategic tips for advocates. This content is incredibly thorough and useful in helping advocates set up a plan to engage with the public and Medicaid agencies.  

  1. Devise strategic and pointed questions for Medicaid agencies. Fortunately, Missouri’s Renewals and Ending the PHE Taskforce has crafted questions (found here) that can be used to understand state plans and help the public stay well-informed on how to navigate these plans.  

In Missouri, stakeholders brought together by Kids Win Missouri have formed the Renewals and Ending the PHE Taskforce, comprised of a variety of advocates including providers, legal aids organizations, budget groups, child advocates and others. Through monthly meetings, the taskforce has prioritized its goals, determined key questions for the state and secured a meeting with the state’s Medicaid agency to determine the state’s plan for unwinding the PHE. The taskforce plans to continue meeting and remain in communication with the state to provide input and feedback on the unwinding process and also serve as a venue for monitoring and providing oversight. 

Thank you to Kids Win Missouri for allowing us to feature your questions to state agencies that advocates can utilize in their quest to understand how their state will equitably and responsibly unwind PHE protections.  

How is your state planning to unwind PHE protections? Email me at to let me know.