Medicaid Unwinding

The Medicaid Unwinding Toolkit for Tribal Enrollment Assisters was created by the National Indian Health Board (NIHB), in collaboration with the Indian Health Service (IHS), to familiarize Tribal health facility staff with the upcoming “Medicaid Unwinding.” The Medicaid Unwinding process could result in millions of individuals across the country losing their health care coverage, and American Indians and Alaska Natives are no exception. NIHB estimates that as many as 236,000 American Indians and Alaska Natives could lose their Medicaid coverage due to the unwinding of the COVID-19 Public Health Emergency (PHE). Tribally operated health care facilities must understand how to prevent as many patients as possible from falling off Medicaid coverage and assist those who need to change health care coverage plans due to changes in their circumstances, financially, or otherwise.

At the onset of the PHE, many flexibilities and changes occurred to Medicaid health care coverage including expanding Medicaid coverage. This expansion allowed many American Indians and Alaska Natives to enroll in Medicaid, and they have since relied on it as their health insurance. Additionally, Tribal health care facilities and hospitals rely heavily on third-party revenue from the Centers for Medicare and Medicaid Services (CMS) to provide the health care and community care services critical to improving the health and well-being of American Indian and Alaska Native people. This Medicaid expansion increased access to health care for American Indians and Alaska Natives and provided much-needed revenue to Tribal health facilities and hospitals.

As the COVID-19 pandemic transitions to an endemic, the PHE will end, resulting in CMS and state Medicaid agencies returning to normal operations–ending the many flexibilities and provisions provided during the PHE. We all must work together to ensure that eligible American Indians and Alaska Natives remain enrolled in their Medicaid healthcare plans.

This toolkit highlights the many consequences of the Medicaid Unwinding process and provides information that is easy to understand and relay to others. Additionally, the toolkit emphasizes ways states and enrollment assisters should work together to identify and solve enrollment issues related to the unwinding.

Medicaid Unwinding Toolkit for Tribal Enrollment Assisters Includes:

• Summary of Medicaid Unwinding guidance
• Recommendations on how to prevent a Medicaid redetermination crisis
• Summary of Medicaid telehealth flexibilities
• Information on the potential impact of Medicaid Unwinding in Tribal communities
• Frequently asked questions and other resources